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PubMed1983

The application of the free-market economic model in Chile and the effects on the population's health status.

After the military coup in 1973, probably the most dogmatic application ever of free-market economic policies was implemented in Chile. The military junta has credited the drop in infant mortality since then to the free-market model. This article explores whether lower infant mortality rates are due to improvements in the socioeconomic conditions created by the free-market, or whether they are due to state-sponsored health care services. It concludes that the socioeconomic conditions since 1973 have generally deteriorated, while government supplemental feeding programs and maternal and child health care services have increased. It appears that the free-market has not been the primary determinant of the decline in infant mortality. Rather, state intervention appears to have been more important. Other morbidity statistics, however, indicate a decline in the population's health status since 1973.

Child Health Services↗
PubMed1997

Technical and economic models to support heifer management decisions: basic concepts.

To maximize herd profits, dairy farmers are faced with the complex dilemma of minimizing costs that are associated with rearing heifers while ensuring or enhancing lifetime economic productivity. Decisions about heifer management interact with underlying biological aspects of growth, thereby influencing future profitability. A thorough understanding of these biological interactions is lacking. Studies based on models could be useful in the evaluation of various rearing strategies. Currently available models for dairy cattle primarily focus on the dairy cow. In a dairy farm production system, management decisions concerning the rearing of livestock and the replacement of dairy cows strongly influence each other. In a model that describes the dairy herd as a multiple-component system, opportunity is greater to coordinate rearing and replacement policies. Expected benefits of such a model are discussed.

Animals↗
PubMedDate not supplied

[Analysis of a economic model of a populational influenza immunization strategy in healthy employees].

BACKGROUND: A debate exists as to whether it is advisable to extend the influenza immunization programs to the entire population, possibly due to the economic impact of this measure. This study is aimed at analyzing the cost-benefit ratio of an influenza immunization strategy among our country's working population. METHODS: Economic study from a social standpoint, including the direct and indirect costs (lost productive time, adverse effects) of the immunization. The costs avoided include the loss of productivity (from the human capital standpoint) and the health costs avoided when the infection is prevented. A costs avoided/costs incurred ratio, known as the Return Rate (RR) is constructed. The costs are converted into constant 2003 Euros. The data was compiled from published sources and a sensitivity analysis presented. RESULTS: The average cost of each immunization is 13.58 (95% CI 13.54-13.62) Euros. Each case of influenza avoided saves an average expense of 374.71 (95% CI 372.59-376.83) Euros. Every 1000 immunizations would avoid an average of 29.3 influenza cases (95% CI 29.0-29.5). The net cost of immunization is 2.60 (95% CI 2.51-2.70) euros. The RR has an average value of 0.80 (95% CI 0.79-0.81), median 0.74, interquartile range (0.53-1.02) Euros. In the case of avoiding more than 36 cases of influenza per 1000 immunizations, the RR takes on values >1. CONCLUSIONS: The influenza immunization strategy for the working population is solely cost-effective for situations of high influence incidence and high vaccine effectiveness.

Economics↗
PubMed2001

Combining drug-disease and economic modelling to inform drug development decisions.

Drug-disease models and clinical trial simulations are increasingly being used to support trial design and treatment optimization decisions. Less widely recognized is their potential for guiding strategic development decisions. These decisions require economic valuation of the potential product profile of efficacy, safety, ease of use, and so on. This review presents a disguised case study that uses drug-disease modelling to generate a probabilistic forecast of a drug's profile. This allows a quantitative analysis of whether to pursue a once-a-day regimen for an antiretroviral being tested twice-a-day in Phase II trials, and if so, at what dose and for which market segments.

Journal Article↗
PubMed2006

Economic modeling of the rational consumption of addictive substances.

This article gives an overview of the way economists model the decision to consume addictive commodities and reviews some of the relevant literature testing aspects of the model. It aims to answer the question of how it is that economists can speak of the consumption of addictive harmful commodities as a rational decision. Health economics treats the consumption of commodities that have beneficial (or harmful) effects on health, and therefore on utility or well-being, as intertemporal decisions with regard to investment decisions. In investment in health, the payoff to an action comes appreciably later than the action itself. The decision to consume harmful, and even addictive, commodities fits into the investment in health framework, with the benefit comes now, in the form of the pleasure derived from consuming them, and the costs, in terms of damage to the individual's health, comes later. The value that a person places on the future vs. the present is called time preference or subjective rate of time discounting, which represents the weight he places on the future relative to the present when he makes decisions that have future consequences. The more they discount the future, the more myopic they are and the more likely to undertake risky behaviors, including smoking or using drugs such as amphetamines or heroin, as well as dropping out of school or taking on high risk jobs.

Behavior, Addictive↗
PubMed1993

Recruiting physicians for rural states: a comparative, socio-economical model.

Recruitment of physicians to rural states is complicated by several barriers precipitated by non-metropolitan locations. These constraints need to be addressed and put into proper perspective in order to attract the interest of potential candidates. This case study addresses our efforts to educate the candidate regarding the potential foregone, social and economical practice opportunity benefits associated with our rural location.

Group Practice↗
PubMedDate not supplied

An economic model for nurse manpower planning in the Caribbean: Part II--Strategies.

Figure 5 illustrates the key ingredients of manpower planning. Whatever model or framework that have or will be considered for the Region must be based on cost containment necessitated by the scarcity of resources. Since the health sector is labour intensive, health manpower is critical for its successful functioning. Approximately 65-70% of the Ministries of Health's recurrent budget is allocated for health personnel. Budgetary restrictions as a result of economic downturn have therefore impacted severely on the manpower resources resulting in a decreased supply of all categories of health workers in the health service. Even the most minimum level of services is therefore jeopardized. Most countries of the Region are at present suffering from a net loss in most of the health professional groups and some countries are without auxiliary groups. In providing quality care, certain questions need to be answered. In the light of decreasing economic resources and accompanying decreasing nurse manpower resources: 1. What degree of substitutability between categories of health manpower generally and specifically, between different categories of nurses will affect their efficient use and provide quality care? 2. What are the least cost combinations of nurse manpower that will ensure greater productivity and quality care? 3. What are the policy restrictions that may hinder substitutability? 4. What are the market forces that affect the demand and supply of nurses? In all of the above, it is necessary to understand that the basis of any nurse manpower policy and plan and the economic analysis of these is guided by the demand for health care and services as well as economics within a given country.

Economics, Nursing↗
PubMed1993

Recruiting physicians for rural states: a comparative, socio-economical model.

Recruitment of physicians to rural states is complicated by several barriers precipitated by non-metropolitan locations. These constraints need to be addressed and put into proper perspective in order to attract the interest of potential candidates. This case study addresses our efforts to educate the candidate regarding the potential foregone, social and economical practice opportunity benefits associated with our rural location.

Humans↗
PubMed2006

Comparing the cost of nurse practitioners and GPs in primary care: modelling economic data from randomised trials.

BACKGROUND: The role of nurse practitioners in primary care has recently expanded. While there are some outcome data available for different types of consultations, little is known about the relative cost. AIM: To compare the cost of primary care provided by nurse practitioners with that of salaried GPs. DESIGN OF STUDY: Synthesis, modelling, and analysis of published data from the perspective of general practices and the NHS. DATA SOURCES: Two published randomised controlled trials. METHOD: A dataset of resource use for a simulated group of patients in a typical consultation was modelled. Current unit costs were used to obtain a consensus mean cost per consultation. RESULTS: Mean cost of a nurse practitioner consultation was estimated at 9.46 UK pounds (95% confidence interval [CI] = 9.16 to 9.75 pounds) and for a GP was 9.30 UK pounds (95% CI = 9.04 to 9.56 pounds) according to salary and overheads, that is, from the perspective of general practices. From the NHS perspective, which included training costs, the estimated mean costs were 30.35 UK pounds (95% CI = 27.10 to 33.59 pounds) and 28.14 UK pounds (95% CI = 25.43 to 30.84 pounds) respectively. Sensitivity analysis suggested that the time spent by GPs contributing to nurse practitioners' consultations (including return visits) was an important factor in increasing costs associated with nurse practitioners. CONCLUSION: Employing a nurse practitioner in primary care is likely to cost much the same as employing a salaried GP according to currently available data. There is considerable variability of qualifications and experience of nurse practitioners, which suggests that skill-mix decisions should depend on the full range of roles and responsibilities rather than cost.

Family Practice↗
PubMed1982

Post-neonatal mortality in rural India: implications of an economic model.

In this paper we develop and test a theory of childhood mortality after the first month of life. Parents are assumed to have well-defined family size and sex composition objectives and to face severe budget constraints. In this set of circumstances, it is understandable that they will make allocative decisions that will affect the survival probabilities of children. These decisions and the environmental influences on mortality are the basic forces which determine whether a child will survive through the post-neonatal period. The model is tested with survey data from rural Uttar Pradesh, India. The results are consistent with the hypothetical framework discussed above. The burden of this pattern of choice is felt particularly strongly by female births.

Attitude↗
PubMed1986

An economic model of teenage pregnancy decision-making.

In this paper, we model unmarried teenagers' decisions about their pregnancy outcome by considering that the teenager contrasts her expected utility (1) as a married mother, (2) as an unmarried mother, or (3) after abortion. We use cross-sectional data on 297 California teenagers aged 13-19 who were pregnant for the first time between 1972 and 1974. Both Anglo and Mexican-American girls are included. We find that pregnant girls who are eligible for or are receiving public assistance are more likely to give birth and remain unmarried. Teenagers with greater time values are more likely to choose abortion, and Mexican-American girls are more likely to carry their pregnancies to term.

Abortion, Legal↗
PubMed2002

The cost-effectiveness of population Helicobacter pylori screening and treatment: a Markov model using economic data from a randomized controlled trial.

BACKGROUND: Economic models have suggested that population Helicobacter pylori screening and treatment may be a cost-effective method of reducing mortality from gastric cancer. These models are conservative as they do not consider that the programme may reduce health service peptic ulcer and other dyspepsia costs. We have evaluated the economic impact of population H. pylori screening and treatment over 2 years in a randomized controlled trial and have incorporated the results into an economic model exploring the impact of H. pylori eradication on peptic ulcer disease and gastric cancer. METHODS: Subjects between the ages of 40 and 49 years were randomly invited to attend their local primary care centre. H. pylori status was evaluated by (13)C-urea breath test and infected individuals were randomized to receive omeprazole, 20 mg b.d., clarithromycin, 250 mg b.d., and tinidazole, 500 mg b.d., for 7 days or identical placebos. Economic data on health service costs for dyspepsia were obtained from a primary care note review for the 2 years following randomization. These data were incorporated into a Markov model comparing population H. pylori screening and treatment with no intervention. RESULTS: A total of 2329 of 8407 subjects were H. pylori positive: 1161 were randomized to receive eradication therapy and 1163 to receive placebo. The cost difference favoured the intervention group 2 years after randomization, but this did not reach statistical significance (11.42 ponds sterling per subject cost saving; 95% confidence interval, 30.04 ponds sterling to -7.19 pounds sterling; P=0.23). Analysis by gender suggested a statistically significant dyspepsia cost saving in men (27.17 ponds sterling per subject; 95% confidence interval, 50.01 pounds sterling to 4.32 pounds sterling; P=0.02), with no benefit in women (-4.46 per subject; 95% confidence interval, -33.85 pounds sterling to 24.93 pounds sterling). Modelling of these data suggested that population H. pylori screening and treatment for 1,000,000 45-year-olds would save over 6,000,000 pounds sterling and 1300 years of life. The programme would cost 14, 200 pounds sterling per life year saved if the health service dyspepsia cost savings were the lower limit of the 95% confidence intervals and H. pylori eradication had only a 10% efficacy in reducing mortality from distal gastric cancer and peptic ulcer disease. CONCLUSIONS: Modelling suggests that population H. pylori screening and treatment are likely to be cost-effective and could be the first cost-neutral screening programme. This provides a further mandate for clinical trials to evaluate the efficacy of population H. pylori screening and treatment in preventing mortality from gastric cancer and peptic ulcer disease.

Adult↗
PubMed1990

Dietary energy levels for growing-finishing pigs fed ad libitum. 2. Carcass effects and economic model of the responses.

The NRC (1988) recommendations on nutrient standards for growing-finishing pigs assume a corn-based feeding regime. However, the diets used in Western Canada are generally barley-based and consequently are usually lower in digestible energy (DE) and result in reduced growth rate and feed efficiency. Corn and wheat can be included in the diet to raise the DE level, but since this could affect the carcass quality of pigs fed ad libitum, the influence of DE level in relation to carcass quality was measured in two experiments. An economic assessment of the data was also conducted. A total of 432 pigs was used, over the 20-98 kg live weight range. The inclusion of wheat or corn to barley-based diets during the finisher period resulted in reduced carcass quality, and there was also some evidence that increased dietary energy during the grower stage had the same effect.

Adipose Tissue↗
PubMed2000

Economic models of animal communication.

Many models of animal signal evolution fail to incorporate an explicit strategy for receivers prior to the evolution of signals. When reasonable assumptions are made for such strategies, we have shown that there is a minimal accuracy of signal coding that is required before receivers should attend to signals (Bradbury & Vehrencamp 1998, Principles of Animal Communication). Depending upon the relative payoffs of correct and incorrect decisions by receivers, this minimal accuracy can be quite high. Here we use this result to explain why so many signals appear to be traits that provided useful information to receivers before becoming ritualized into signals. Our model also supports one prediction of sensory drive models: that latent preferences may selectively favour some signal precursors over others. However, it imposes a serious constraint on sensory drive by requiring that there be sufficient benefits to a receiver to compensate for the costs of disrupting the optimal receiver strategy used before exploitation. Finally, we discuss the overlap between signal honesty and accuracy and show how senders that completely disagree with receivers about appropriate receiver decisions may still benefit by providing moderately honest and accurate signals. Copyright 2000 The Association for the Study of Animal Behaviour.

Journal Article↗
PubMed2001

An economic model to assess the cost and benefits of the routine use of silver alloy coated urinary catheters to reduce the risk of urinary tract infections in catheterized patients.

Prevalence studies generally find nosocomial urinary tract infections to be the most common type of nosocomial infection, accounting for between 21% and 45% of all HAIs. The main risk factor appears to be the presence of a urinary catheter, with an estimated 80% of these infections being associated with their use. This paper describes a model which quantifies the extent of the burden of these infections in terms of the number of patients affected and the costs incurred by the hospital sector; and identifies the potential benefits of the routine use of silver alloy coated catheters, as a means of reducing the incidence of this type of infection. An illustrative model of the annual costs and benefits associated with the routine use of this intervention in adult, non-day case patients admitted to the medical and surgical specialties of NHS hospitals throughout England is presented. The results suggest that a 14.6% reduction in the incidence of urinary tract infections in catheterized medical patients, and a 11.4% reduction in catheterized surgical patients, would cover the cost of the intervention. Any further reduction in incidence would result in net positive benefits.

Adult↗