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on Health Economics |
| By: | Kurt R. Brekke; Michael Kuhn |
| Abstract: | We study effects of direct-to-consumer advertising (DTCA) in the prescription drug market. There are two pharmaceutical firms providing horizontally differentiated (branded) drugs. Patients differ in their susceptibility to the drugs. If DTCA is allowed, this can be employed to induce (additional) patient visits. Physicians perfectly observe the patients' type (of illness), but rely on information to prescribe the correct drug. Drug information is conveyed by marketing (detailing), creating a captive and a selective segment of physicians. First, we show that detailing, DTCA and price (if not regulated) are complementary strategies for the firms. Thus, allowing DTCA induces more detailing and higher prices. Second, firms benefit from DTCA if detailing competition is not too fierce, which is true if investing in detailing is sufficiently costly. Otherwise, firms are better off with a ban on DTCA. Finally, DTCA tends to lower welfare if insurance is generous (low copayments) and/or price regulation is lenient. The desirability of DTCA also depends on whether or not the regulator is concerned with firms' profit. |
| Keywords: | marketing, pharmaceuticals, oligopoly |
| JEL: | I11 L13 L65 M37 |
| Date: | 2005 |
| URL: | http://d.repec.org/n?u=RePEc:ces:ceswps:_1493&r=hea |
| By: | Anja Deelen |
| Abstract: | In this paper, we analyse the employers' decision to opt out of the public disability insurance (DI) system. For the empirical analysis we use an extensive panel of Dutch employers for the period 2000-2002. We find that cross-subsidies employers pay or receive under the current public insurance system of experience rating contribute to the opting out decision. Since cross-subsidies are risk related, this is an indication for the presence of adverse selection: high risk (cross-subsidised) firms tend to remain publicly insured, while low risk (cross subsidising) firms tend to opt out. This finding is supported by the fact that risk related characteristics such as the sector of industry and the composition of the work force by age and gender contribute to the explanation of the opting-out decision. Adverse selection could be diminished by setting public premiums in such a way that they are more actuarial fair in the long run. As a result, the risk profile of firms opting out will become more similar to that of firms not opting out. |
| Keywords: | adverse selection; cross-subsidies; disability insurance; premium differentiation |
| URL: | http://d.repec.org/n?u=RePEc:cpb:discus:46&r=hea |
| By: | Francisco Aguado Correa; Maria Jose Alvarez Gil; Lucia Barcos Redin |
| Abstract: | The performance management process in health care is far behind compared to the manufacturing and service industries. Although nowadays the health care organizations are able to deal with a greater rank diseases, their cost, quality and delivery has essentially not improved significantly, and the difference with the other industries even seems to have increased. As opposed to this situation health care has a tremendous opportunity to deploy lean principles to reduce internal/external costs, improve patient safety, increase profits, reduce litigation and decrease the dependence on Government and Insurance. The application of these principles is being facilitated by the use of the new technologies. A new technology allowing personnel to constantly "see" what’s happening with regards to patients schedule, backlog, workflow, inventory levels, resource utilization, quality, etc., is Radio Frequency Identification (RFID). The aim of this paper is to analyse the benefits that can be derived from the joint use of lean principles and RFID technology in health care. |
| Date: | 2005–07 |
| URL: | http://d.repec.org/n?u=RePEc:cte:wbrepe:wb054410&r=hea |
| By: | Andrew E. Clark (CNRS, PSE and IZA Bonn); Fabrice Etilé (INRA-CORELA) |
| Abstract: | We use nine waves of BHPS data to examine interactions between spouses in terms of a behaviour with important health repercussions: cigarette smoking. Correlation between partners’ behaviours may be due to correlated effects, as a consequence of matching or information revealed by others' behaviours, or to endogenous effects generated by bargaining within marriage. A simple bivariate probit reveals a positive correlation between own current smoking and partner’s past smoking, which is consistent with endogenous effects. However, after controlling for individual effects, we find that own current smoking and partner’s past smoking are statistically independent: all of the correlation in smoking status works through the correlation in individual effects. As such the correlation in the raw smoking data is consistent with positive assortative matching in marriage over smoking, rather than bargaining within the couple or social learning. |
| Keywords: | smoking, matching, bargaining, learning, health |
| JEL: | C33 D83 I12 I18 |
| Date: | 2005–07 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp1692&r=hea |
| By: | Béatrice d’Hombres (University of Padova); Giorgio Brunello (University of Padova, CESifo and IZA Bonn) |
| Abstract: | We use data from the European Community Household Panel to investigate the impact of obesity on wages in 9 European countries, ranging from Ireland to Spain. We find that the common impact of obesity on wages is negative and statistically significant, independently of gender. Given the nature of European labor markets, however, we believe that a common impact is overly restrictive. When we allow this impact to vary across countries, we find a negative relationship between the BMI and wages in the countries of the European "olive belt" and a positive relationship in the countries of the "beer belt". We speculate that such difference could be driven by the interaction between the weather, BMI and individual (unobserved) productivity. |
| Keywords: | wages, body mass index, Europe |
| JEL: | I12 J3 |
| Date: | 2005–07 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp1704&r=hea |
| By: | Ginger Zhe Jin; Alan T. Sorensen |
| Abstract: | We use data on the enrollment decisions of federal annuitants to estimate the influence of publicized ratings on health plan choice. We focus on the impact of ratings disseminated by the National Committee for Quality Assurance (NCQA), and use our estimates to calculate the value of the information. Our approach exploits a novel feature of the data—the availability of nonpublic plan ratings—to correct for a source of bias that is inherent in studies of consumer responsiveness to information on product quality: since publicized ratings are correlated with other quality signals known to consumers (but unobserved by researchers), the estimated influence of ratings is likely to be overstated. We control for this bias by comparing the estimated impact of publicized ratings to the estimated impact of ratings that were never disclosed. The results indicate that NCQA’s plan ratings had a meaningful influence on individuals’ choices, particularly for individuals choosing a plan for the first time. Although we estimate that a very small fraction of individual decisions were materially affected by the information, for those that were affected the implied utility gains are substantial. |
| JEL: | I11 L15 |
| Date: | 2005–08 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:11514&r=hea |
| By: | Anna Aizer; Sara McLanahan |
| Abstract: | Increasing the probability of paying child support, in addition to increasing resources available for investment in children, may also alter the incentives faced by men to have children out of wedlock. We find that strengthening child support enforcement leads men to have fewer out-of-wedlock births and among those who do become fathers, to do so with more educated women and those with a higher propensity to invest in children. Thus, policies that compel men to pay child support may affect child outcomes through two pathways: an increase in financial resources and a birth selection process. |
| JEL: | J12 J13 I38 |
| Date: | 2005–08 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:11522&r=hea |
| By: | Jay Bhattacharya; Neeraj Sood |
| Abstract: | If rational individuals pay the full costs of their decisions about food intake and exercise, economists, policy makers, and public health officials should treat the obesity epidemic as a matter of indifference. In this paper, we show that, as long as insurance premiums are not risk rated for obesity, health insurance coverage systematically shields those covered from the full costs of physical inactivity and overeating. Since the obese consume significantly more medical resources than the non-obese, but pay the same health insurance premiums, they impose a negative externality on normal weight individuals in their insurance pool. To estimate the size of this externality, we develop a model of weight loss and health insurance under two regimes——(1) underwriting on weight is allowed, and (2) underwriting on weight is not allowed. We show that under regime (1), there is no obesity externality. Under regime (2), where there is an obesity externality, all plan participants face inefficient incentives to undertake unpleasant dieting and exercise. These reduced incentives lead to inefficient increases in body weight, and reduced social welfare. Using data on medical expenditures and body weight from the National Health and Interview Survey and the Medical Expenditure Panel Survey, we estimate that, in a health plan with a coinsurance rate of 17.5%, the obesity externality imposes a welfare cost of about $150 per capita. Our results also indicate that the welfare loss can be reduced by technological change that lowers the pecuniary and non-pecuniary costs of losing weight, and also by increasing the coinsurance rate. |
| JEL: | I1 D6 |
| Date: | 2005–08 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:11529&r=hea |
| By: | Stéphanie Guichard |
| Abstract: | <P>An ambitious reform to increase efficiency of the Portuguese health care system was launched in 2002. In contrast to previous attempts of gradual reforms, which were never fully implemented, the strategy has been to create a big bang in the health sector, making changes essentially irreversible. The reform has two main aims: to deliver better-quality public health services than at present but at no higher cost; and to reduce the underlying growth rate of public health-care spending over the medium term. New legislation approved includes the separation of the functions of regulation, financing and provision of health care services; setting up new models of financing for providers, which impose harder budget constraints; the introduction of incentives towards productivity, management and quality improvements; the possibility for the private sector to play a larger role in service provision; and the promotion of generic drugs. After assessing the strengths and weaknesses of the ...</P> <P>La réforme du système de santé au Portugal <P>Une réforme ambitieuse a été engagée en 2002 au Portugal pour accroître l’efficience du système de santé. Contrairement aux tentatives précédentes de réformes graduelles, qui n’ont jamais été totalement mises en œuvre, la stratégie consiste à susciter un big-bang dans le secteur de la santé, rendant les efforts de réforme pour l’essentiel irréversibles. Cette réforme a deux objectifs principaux : améliorer la qualité des services de santé publique sans augmenter les coûts et réduire le taux de croissance sous-jacent des dépenses de santé publique à moyen terme. Les nouvelles législations incluent: la séparation des fonctions de réglementation, de financement et de prestation de services de santé publique ; la mise en place de nouvelles modalités de financement pour les prestataires, qui imposent des contraintes budgétaires plus rigoureuses ; l’introduction d’incitations en faveur de la productivité, de la gestion et de l’amélioration de la qualité; la possibilité pour le secteur ...</P> |
| Keywords: | Health, Santé, Portugal, Portugal |
| JEL: | I10 I11 I12 I18 |
| Date: | 2004–10–06 |
| URL: | http://d.repec.org/n?u=RePEc:oec:ecoaaa:405-en&r=hea |
| By: | Francesca Colombo; Nicole Tapay |
| Abstract: | <P><OL><LI>This paper analyses the Slovak health insurance system and the policy challenges it faces. It describes the structure of health coverage and health sector reforms being implemented by the Slovak government. It provides a preliminary assessment of the possible impact of such reforms, with a focus on the health insurance system and the possible introduction of private health insurance (PHI). It assesses how private health insurance would impact upon the health system, particularly equity, efficiency incentives facing providers and insurers, and responsiveness.</LI> <LI>The Slovak health system is based upon a mandatory Bismarck-style social health insurance system. Contributions are shared between employers and employees and the state contributes for the inactive population. Five non-profit and non-competing insurers operate nationwide, one of which covers two-thirds of the population. Individuals can freely enrol with any of the insurance companies and a risk equalisation system operates ...</LI></OL></P> <P><OL><LI>Ce document présente une analyse du système d’assurance de santé Slovaque et les défis politiques que celui-ci engendre. Une description de la structure de couverture santé et des réformes mises en oeuvre par le gouvernement Slovaque y est présentée ainsi qu’une évaluation préliminaire de l’impact possible de telles réformes. L’accent est porté sur le système d’assurance-maladie et l’introduction possible d’une assurance maladie privée (AMP). Y figure également une évaluation de la manière dont une AMP aura des répercussions sur le système de santé lui-même et plus particulièrement en ce qui concerne l’équité et les incitations à l’efficience auxquelles sont confrontés les fournisseurs de services et les assureurs et la réactivité du système de santé face aux besoins des utilisateurs.</LI> <LI>Le système de santé Slovaque et basé sur un système d’assurance maladie sociale obligatoire du style Bismarck. Les contributions sont partagées entre les employeurs et les employés avec une ...</LI></OL></P> |
| JEL: | I11 I18 I19 |
| Date: | 2004–03–05 |
| URL: | http://d.repec.org/n?u=RePEc:oec:elsaac:11-en&r=hea |
| By: | Francesca Colombo; Nicole Tapay |
| Abstract: | <P><OL><LI>This paper analyses the Irish private health insurance (PHI) market. It describes how PHI interacts with the public system, and assesses its contribution to equity, efficiency and responsiveness of the health system. The analysis identifies some of the factors affecting insurance market performance and its impact on the health system, including market characteristics, the regulatory and fiscal environment, health system organisation, and any actors’ incentives and behaviours.</LI> <LI>PHI plays a prominent role in Ireland. The health system is designed to offer comprehensive publicly funded health services to low-income groups, and universal public hospital coverage. Policies have encouraged the development of PHI to provide all individuals with a private alternative to the public system, as well as a means of funding cost-sharing and services not covered by the public system. With the implementation of the requirements of the Third EU Non-Life Directive, the PHI market, historically ...</LI></OL></P> <P><OL><LI>Cet article analyse le marché de l'assurance maladie privée (AMP) en Irlande. Il décrit comment l'assurance maladie privée interagit avec le système public et évalue sa contribution à l’équité, l'efficacité et la réactivité du système de santé. Cette analyse identifie certains facteurs affectant la performance, y compris les caractéristiques du marché de l'assurance privée, la régulation et le cadre financier, l'organisation du système de santé, ainsi que les incitations et le comportement des différents acteurs.</LI> <LI>L'AMP joue un rôle important en Irlande. Le système de santé offre des services de santé complets financés par des fonds publics aux groupes à bas revenus ainsi qu’une couverture universelle de frais d’hospitalisation. Les politiques de la santé ont encouragé le développement de l'AMP afin d’assurer à tous les individus une alternative au système public ainsi qu’un moyen pour financier le ticket modérateur et les services qui ne sont pas couverts par le système public ...</LI></OL></P> |
| JEL: | I11 I18 I19 |
| Date: | 2004–02–12 |
| URL: | http://d.repec.org/n?u=RePEc:oec:elsaad:10-en&r=hea |
| By: | Francesca Colombo; Nicole Tapay |
| Abstract: | <P><OL><LI>This paper analyses the Slovak health insurance system and the policy challenges it faces. It describes the structure of health coverage and health sector reforms being implemented by the Slovak government. It provides a preliminary assessment of the possible impact of such reforms, with a focus on the health insurance system and the possible introduction of private health insurance (PHI). It assesses how private health insurance would impact upon the health system, particularly equity, efficiency incentives facing providers and insurers, and responsiveness.</LI></OL></P><P><OL><LI>The Slovak health system is based upon a mandatory Bismarck-style social health insurance system. Contributions are shared between employers and employees and the state contributes for the inactive population. Five non-profit and non-competing insurers operate nationwide, one of which covers two-thirds of the population. Individuals can freely enrol with any of the insurance companies and a risk equalisation system ...</LI></OL></P> <P><OL><LI>Ce document présente une analyse du système d’assurance de santé Slovaque et les défis politiques que celui-ci engendre. Une description de la structure de couverture santé et des réformes mises en oeuvre par le gouvernement Slovaque y est présentée ainsi qu’une évaluation préliminaire de l’impact possible de telles réformes. L’accent est porté sur le système d’assurance-maladie et l’introduction possible d’une assurance maladie privée (AMP). Y figure également une évaluation de la manière dont une AMP aura des répercussions sur le système de santé lui-même et plus particulièrement en ce qui concerne l’équité et les incitations à l’efficience auxquelles sont confrontés les fournisseurs de services et les assureurs et la réactivité du système de santé face aux besoins des utilisateurs.</LI></OL></P><P><OL><LI>Le système de santé Slovaque et basé sur un système d’assurance maladie sociale obligatoire du style Bismarck. Les contributions sont partagées entre les employeurs et les employés avec une ...</LI></OL></P> |
| JEL: | I11 I18 I19 |
| Date: | 2004–03–05 |
| URL: | http://d.repec.org/n?u=RePEc:oec:elsaad:11-en&r=hea |
| By: | Thomas C. Buchmueller; Agnes Couffinhal |
| Abstract: | <P><OL><LI>While France has a universal public health insurance system, the coverage it provides is incomplete and the vast majority the French population has private complementary health insurance. Among OECD countries, the share of health care financed by private insurance is third highest behind the US and the Netherlands, two countries where private coverage is the primary source of payment for a large percentage of the population.</LI> <LI>France’s high rate of private insurance coverage is partly explained by historical factors and partly by the preferential tax treatment of employer-sponsored coverage. Because of the high rate of employerprovision – roughly half of all contracts are obtained through the workplace – coverage tends to vary with activity and industry classification. Historically, coverage was also positively related with income. In 2000, the French government introduced a new program, the <I>Couverture Maladie Universelle</I> (CMU), which extended eligibility for publicly funded ...</LI></OL></P> <P><OL><LI>Si la France a un système d'assurance maladie publique universel, la couverture qu'il propose n'est pas complète et la majorité de la population française a une assurance complémentaire privée. La France est le troisième pays de l'OCDE en ce qui concerne la part des dépenses de santé financée par l'assurance privée, après les Etats-Unis et les Pays-Bas, deux pays où l'assurance privée représente la seule source de couverture pour une grande partie de la population.</LI> <LI>L'importance de l'assurance privée en France s'explique pour partie par des facteurs historiques mais aussi par le traitement fiscal préférentiel dont bénéficient les assurances de groupe. Etant donnée qu'environ la moitié des contrats sont obtenus par le biais de l'emploi, la couverture est très liée à la participation au marché du travail et au secteur d'activité. Historiquement, le taux couverture de la population augmentait avec le revenu. En 2000, le gouvernement a mis en place un nouveau programme public, la ...</LI></OL></P> |
| JEL: | I11 I18 I19 |
| Date: | 2004–03–11 |
| URL: | http://d.repec.org/n?u=RePEc:oec:elsaad:12-en&r=hea |
| By: | Pierre Moise; Michael Schwarzinger; Myung-Yong Um |
| Abstract: | <P><OL><LI>Dementia and its most common manifestation, Alzheimer’s disease, is a complex disorder that afflicts primarily the elderly, affecting an estimated 10 million people in OECD member countries. The complexity of the disease makes treating dementia extremely difficult, involving a wide variety of social and health care interventions. Typically, these two aspects of dementia care are examined separately. This paper adopts a conceptual model that examines both types of interventions and how they interact along the dementia care continuum.</LI></OL></P><P><OL><LI>There are no effective health care treatments for stopping dementia, which is why the social care aspect plays an important role in treating the disease, with family members an integral part of this process. This paper shows that programs designed to help alleviate the burden of family members caring for a relative with dementia can have positive health benefits to both patient and family. In particular, the use of group-living, where dementia ...</LI></OL></P> <P><OL><LI>La démence et la maladie d’Alzheimer, sa manifestation la plus courante, sont des troubles complexes qui touchent principalement les personnes âgées. D’après les estimations, elles concernent quelque 10 millions d’individus dans les pays de l’OCDE. La complexité de ces pathologies rend extrêmement difficile toute méthode de soins et nécessite une prise en charge à la fois sociale et médicale. Le plus souvent, ces deux aspects de la prise en charge de la démence sont examinés séparément. La logique conceptuelle adoptée dans le présent document en propose une analyse globale et étudie leur interaction tout au long du continuum de soins.</LI></OL></P><P><OL><LI>Il n’existe aucun traitement efficace permettant d’arrêter la progression de la démence ; c’est la raison pour laquelle l’entourage familial joue un rôle fondamental dans sa prise en charge, dont il fait partie intégrante. Le présent document montre que les programmes visant à alléger le fardeau des personnes s’occupant d’un proche atteint de ...</LI></OL></P> |
| JEL: | I10 I18 I19 |
| Date: | 2004–07–28 |
| URL: | http://d.repec.org/n?u=RePEc:oec:elsaad:13-en&r=hea |
| By: | Cristina Masseria; Eddy van Doorslaer |
| Abstract: | <P><OL><LI>This study updates and extends a previous study on equity in physician utilisation for a subset of the countries analyzed here (Van Doorslaer, Koolman and Puffer, 2002). It updates results to 2000 for 13 countries and adds new results for eight countries: Australia, Finland, France, Hungary, Mexico, Norway, Switzerland and Sweden. Both simple quintile distributions and concentration indices were used to assess <I>horizontal equity, i.e.</I> the extent to which adults in equal need for physician care appear to have equal rates of medical care utilisation.</LI> <LI>With respect to <I>physician utilisation</I>, need is more concentrated among the worse off, but after “standardizing out” these need differences, significant horizontal inequity favoring the better off is found in about half of the countries, both for the probability and the total number of visits. The degree of pro-rich inequity in doctor use is highest in the US, followed by Mexico, Finland, Portugal and Sweden.</LI> <LI>In the majority ...</LI></OL></P> <P><OL><LI>Cette étude actualise et étend le champ d'investigation d'une étude antérieure sur l'équité de l'utilisation des services des médecins effectuée pour un sous-ensemble de pays analysés ici (Van Doorslaer, Koolman et Puffer, 2002). Elle actualise les résultats jusqu’à l’année 2000 pour treize pays et incorpore de nouveaux résultats pour huit autres pays de l'OCDE : l’Australie, la Finlande, la France, la Hongrie, le Mexique, la Norvège, la Suisse et la Suède. Elle utilise à la fois les distributions par quintile et les indices de concentration pour évaluer l'<I>équité horizontale</I>, c’est-à-dire dans quelle mesure des adultes ayant un égal besoin de soins médicaux ont apparemment des taux identiques d'utilisation de soins médicaux.</LI> <LI>Pour ce qui est de l'<I>utilisation des médecins</I>, les besoins en services médicaux ont tendance à être plus concentrés parmi les catégories défavorisées, mais après avoir pris en compte ces différences de besoins, on observe une iniquité horizontale positive ...</LI></OL></P> |
| JEL: | I11 I18 I19 |
| Date: | 2004–05–11 |
| URL: | http://d.repec.org/n?u=RePEc:oec:elsaad:14-en&r=hea |
| By: | Francesca Colombo; Nicole Tapay |
| Abstract: | <P><OL><LI>Governments often look to private health insurance (PHI) as a possible means of addressing some health system challenges. For example, they may consider enhancing its role as an alternative source of health financing and a way to increase system capacity, or promoting it as a tool to further additional health policy goals, such as enhanced individual responsibility. In some countries policy makers regard PHI as a key element of their health coverage systems</LI></OL></P><P><OL><LI>While private health insurance represents, on average, only a small share of total health funding across the OECD area, it plays a significant role in health financing in some OECD countries and it covers at least 30% of the population in a third of the OECD members. It also plays a variety of roles, ranging from primary coverage for particular population groups to a supporting role for public systems.</LI></OL></P><P><OL><LI>This paper assesses evidence on the effects of PHI in different national contexts and draws conclusions about its ...</LI></OL></P> <P><OL><LI>Certains gouvernements voient dans l’assurance maladie privée un moyen de relever quelquesuns des défis liés aux systèmes de santé. Par exemple, certains envisagent de promouvoir son rôle de source de financement de substitution, de l’utiliser pour accroître les capacités du système, ou encore de la faire contribuer à la réalisation d’autres objectifs de la politique de santé, tels que le renforcement de la responsabilité individuelle. Dans certains pays, les décideurs considèrent l’assurance maladie privée comme un élément fondamental du système de couverture maladie.</LI></OL></P><P><OL><LI>Bien que l’assurance maladie privée ne représente en moyenne qu’une petite fraction du financement total des dépenses de santé dans la zone OCDE, elle constitue dans quelques pays Membres un mode de financement important des soins et couvre au moins 30 pour cent de la population dans un tiers des pays de l’OCDE. Elle joue par ailleurs des rôles multiples, allant de l’octroi d’une couverture primaire à des ...</LI></OL></P> |
| Date: | 2004 |
| URL: | http://d.repec.org/n?u=RePEc:oec:elsaad:15-en&r=hea |
| By: | David Morgan; Eva Orosz |
| Abstract: | <H2 align="left">The purpose of the System of Health Accounts</H2><P><OL><LI>Changes in health systems and concomitant health policy questions have been challenging the traditional system of health expenditure statistics over the last couple of decades. What are the major factors accounting for health expenditure growth? What factors explain the differences between countries in expenditure growth? How to ensure sustainable financing? What are the major factors accounting for the differences in the structure of health spending? How are the changes in health spending structure and the performance of health systems related? In order to answer such questions, reliable, comparable and appropriately detailed health expenditure data are required. The <I>System of Health Accounts</I> intends to provide the foundation for health statistics that are able to meet these challenges.</LI></OL></P><H2 align="center">Box 1</H2><H3 align="center">What is the System of Health Accounts?</H3><P><I>The System of Health Accounts</I> (SHA) proposes an integrated system of comprehensive and internationally ...</P> |
| JEL: | H51 I10 |
| Date: | 2004–08–06 |
| URL: | http://d.repec.org/n?u=RePEc:oec:elsaad:16-en&r=hea |
| By: | James Buchan; Lynn Calman |
| Abstract: | <P><OL><LI>An important potential contribution to the efficient use of the health workforce, is the possibility of ‘skill mix’ changes. ‘Skill mix’ is a relatively broad term which can refer to the mix of staff in the workforce or the demarcation of roles and activities among different categories of staff. Most of the policy attention on using skill-mix changes to improve health system performance has been on the mix between physicians and nurses.</LI></OL></P><P><OL><LI>Skill-mix changes may involve a variety of developments including enhancement of skills among a particular group of staff, substitution1 between different groups, delegation up and down a unidiscipliniary ladder, and innovation in roles. Such changes may be driven by a variety of motives including service innovation, shortages of particular categories of worker (especially in inner cities or rural areas), quality improvement, and a desire to improve the cost- effectiveness of service delivery.</LI></OL></P><P><OL><LI>There are large differences in reported physician/nurse ...</LI></OL></P> <P><OL><LI>Il existe un moyen susceptible de contribuer de manière importante à l’utilisation rationnelle des personnels de santé, à savoir la modification de « l’éventail des qualifications ». « L’éventail des qualifications » est un concept relativement vaste qui renvoie soit à l’éventail des personnels qualifiés, soit à la séparation des rôles et des activités réservés aux différentes catégories de personnel. Parmi les pistes envisagées dans l’utilisation des modifications de l’éventail des qualifications pour améliorer les performances des systèmes de santé, c’est la substitution du personnel infirmier aux médecins qui a le plus retenu l’attention.</LI></OL></P><P><OL><LI>Les modifications de l’éventail des qualifications peuvent se traduire par des résultats divers, tels que le relèvement des qualifications au sein d’un groupe professionnel donné, une substitution2 entre différents groupes, une délégation des actes vers le haut et vers le haut au sein de la hiérarchie d’une même discipline ou des innovations au ...</LI></OL></P> |
| Date: | 2005–02–24 |
| URL: | http://d.repec.org/n?u=RePEc:oec:elsaad:17-en&r=hea |
| By: | Francesca Colombo; Nicole Tapay |
| Abstract: | <P><OL><LI>Private health insurance (PHI) is the sole source of primary health coverage for a third of the Netherlands’ population earning above a set income threshold. Social insurance (together with limited public (tax-based financing) is the main source of health coverage for the majority of the population. Most socially insured also purchase supplementary private health coverage. All citizens are eligible for a system of coverage for long-term care and care for the chronically ill. Thus, in the Netherlands, the source of health financing is determined according to the category of health risk, type of illness, as well as income level. Decisions have been made allocating the cost of more expensive long-term care and coverage of high-risk individuals and persons earning below a set level, to social or public insurance, or to PHI subsidised by a broader pool.</LI></OL></P><P><OL><LI>From an equity perspective, the Dutch public/private financing mix appears to do well, although challenges remain. There appear to be ...</LI></OL></P> <P><OL><LI>Pour les Néerlandais situés dans le tiers supérieur de l’échelle des revenus, l’assurance maladie privée constitue l’unique source de couverture maladie primaire. L’assurance sociale (et, dans une mesure restreinte, certains financements publics d’origine fiscale) représente pour sa part la principale source de couverture maladie pour la majorité de la population. La plupart des affiliés au régime social sont également titulaires d’une couverture maladie privée supplémentarité. Tous les citoyens sont admissibles à une couverture pour soins de longue durée, et les soins aux malades chroniques sont également couverts. Aux Pays-Bas, la source de financement des soins de santé est donc déterminée selon la catégorie de risque de santé, le type de maladie ainsi que le niveau de revenu. La décision a été prise d’allouer les coûts induits par les soins de longue durée (plus onéreux), les personnes à haut risque et les personnes gagnant moins d’un certain revenu à l’assurance sociale ou ...</LI></OL></P> |
| JEL: | I11 I18 I19 |
| Date: | 2004–12–16 |
| URL: | http://d.repec.org/n?u=RePEc:oec:elsaad:18-en&r=hea |
| By: | Jeremy Hurst; Steven Simoens; Mike Villeneuve |
| Abstract: | <P><OL><LI>There are reports of current nurse shortages in all but a few OECD countries. With further increases in demand for nurses expected and nurse workforce ageing predicted to reduce the supply of nurses, shortages are likely to persist or even increase in the future, unless action is taken to increase flows into and reduce flows out of the workforce or to raise the productivity of nurses.</LI></OL></P><P><OL><LI>This paper analyses shortages of nurses in OECD countries. It defines and describes evidence on current nurse shortages, and analyses international variability in nurse employment. Additionally, a number of demand and supply factors that are likely to influence the existence and extent of any future nurse shortages are examined. In order to resolve nurse shortages, the paper compares and evaluates policy levers that decision makers can use to increase flows of nurses into the workforce, reduce flows out of the workforce, and improve nurse retention rates.</LI></OL></P><P><OL><LI>Although delayed market response may have been ...</LI></OL></P> <P><OL><LI>Tous les pays de l’OCDE, à l’exception de quelques-uns, font état d’une pénurie d’infirmières. Etant donné que la demande d’infirmières va vraisemblablement augmenter encore et que l’offre devrait diminuer sous l’effet du vieillissement de cette population, la pénurie est susceptible de persister, voire de s’aggraver dans l’avenir si des mesures ne sont pas prises pour accroître les flux d’entrées dans la profession et réduire le nombre de sorties, ou pour augmenter la productivité des infirmières.</LI></OL></P><P><OL><LI>Ce document présente une analyse de la pénurie d’infirmières que connaissent actuellement les pays de l’OCDE. Il rend compte des données disponibles sur ce phénomène et examine les différences entre pays dans le domaine de l’emploi infirmier. Il passe également en revue un certain nombre de facteurs qui agissent du côté de la demande et de l’offre et pourraient déterminer l’existence de futures pénuries d’infirmières et l’ampleur qu’elles auront. Afin d’apporter une solution à ce ...</LI></OL></P> |
| Date: | 2005 |
| URL: | http://d.repec.org/n?u=RePEc:oec:elsaad:19-en&r=hea |
| By: | Jeremy Hurst; Luigi Siciliani |
| Abstract: | <P><OL><LI>Waiting times for elective surgery are a significant health policy concern in approximately half of all OECD countries. The main objectives of the OECD Waiting Times project were to: <I>i)</I> review policy initiatives to reduce waiting times in 12 OECD countries; and <I>ii)</I> to investigate the causes of variations in waiting times for non-emergency surgery across countries. The first objective was addressed in an earlier report (Hurst and Siciliani, 2003; OECD Health Working paper, n.6).</LI> <LI>This report is devoted to the second objective. An interesting feature of OECD countries is that while some countries report significant waiting, others do not. Waiting times are a serious health policy issue in the 12 countries involved in this project (Australia, Canada, Denmark, Finland, Ireland, Italy, Netherlands, New Zealand, Norway, Spain, Sweden, and the United Kingdom). Waiting times are not recorded administratively in a second group of countries ...</LI></OL></P> <P><OL><LI>Dans près de la moitié des pays de l’OCDE, les délais d’attente pour les interventions chirurgicales non urgentes constituent un important sujet de préoccupation pour les responsables de la politique de la santé. Le projet de l’OCDE sur ce sujet vise principalement les objectifs suivants : <I>i)</I> examiner les initiatives prises par les pouvoirs publics en vue de réduire ces délais d’attente dans douze pays Membres ; <I>ii)</I> rechercher les causes des différences observées d’un pays à l’autre quant à ces délais. Un précédent rapport a été consacré au premier de ces objectifs (Hurst et Siciliani, 2003 ; document de travail de l’OCDE sur la santé, n°6).</LI> <LI>Le présent document porte sur le second objectif. Il est intéressant de noter que, si certains pays de l’OCDE font état de délais d’attente non négligeables, ce n’est pas le cas pour d’autres. Ces délais posent un épineux problème de fond en matière de santé dans les douze pays qui participent au projet ...</LI></OL></P> |
| Date: | 2003–10–07 |
| URL: | http://d.repec.org/n?u=RePEc:oec:elsaad:7-en&r=hea |
| By: | LAURA LAMBIE; SOEREN MATTKE |
| Abstract: | <P><OL><LI>This report presents the consensus recommendations of an international expert panel on indicators for cardiac care. Using a structured review process, the panel set out to select indicators to cover five key areas: primary prevention, secondary prevention of heart disease, acute coronary syndromes, cardiac interventions and congestive heart failure. In the event, no suitable indicators for primary prevention were retained, and this report proposes 17 indicators as follows:</LI></OL></P><P><OL><LI>The report describes the review process and provides a detailed discussion of the scientific soundness and policy importance of the 17 indicators ...</LI></OL></P> <P><OL><LI>Ce rapport présente les recommandations consensuelles d’un groupe d’experts internationaux sur les indicateurs relatifs aux soins cardiaques. En suivant une méthodologie détaillée, le groupe d’experts a entrepris de sélectionner des indicateurs devant couvrir cinq grands domaines : la prévention primaire, la prévention secondaire des cardiopathies, le syndrome coronarien aigu, la chirurgie cardiaque et l’insuffisance cardiaque congestive. Aucun indicateur satisfaisant pour la prévention primaire n’ayant été retenu, ce rapport propose donc les 17 indicateurs suivants :</LI></OL></P><P><OL><LI>Le rapport décrit la méthodologie employée et démontre, arguments à l’appui, la viabilité scientifique et l’importance stratégique des 17 indicateurs retenus ...</LI></OL></P> |
| Date: | 2004–10–28 |
| URL: | http://d.repec.org/n?u=RePEc:oec:elsaae:14-en&r=hea |
| By: | SHELDON GREENFIELD; SOEREN MATTKE; ANTONIO NICOLUCCI |
| Abstract: | <P><OL><LI>This report presents the recommendations of an international expert group on indicators for diabetes care. Based on a review of existing indicators and an assessment of gaps left open by existing indicators, the experts set out to select indicators to cover clinical processes of diabetes care as well as proximal and distal outcomes of care. The review led to a recommendation of nine indicators as follows ...</LI></OL></P> <P><OL><LI>Ce rapport présente les recommandations d’un groupe d’experts internationaux sur les indicateurs relatifs au diabète. Les experts se sont basés sur un examen des indicateurs existants et ont répertorié les carences d’informations des indicateurs existants pour sélectionner des indicateurs devant couvrir des processus cliniques pour le diabète ainsi que des résultats de soins proximaux et distaux. L’examen a conduit à une recommandation des neuf indicateurs suivants ...</LI></OL></P> |
| Date: | 2004–10–28 |
| URL: | http://d.repec.org/n?u=RePEc:oec:elsaae:15-en&r=hea |
| By: | SHEILA LEATHERMAN; MARTIN MARSHALL; SOEREN MATTKE |
| Abstract: | <P><OL><LI>This report presents the consensus recommendations of an international expert panel on indicators for health promotion and primary care. Using a structured review process, the panel selected a set of 27 indicators to cover the three key areas health promotion, preventive care and diagnosis and treatment in primary care. The report describes the review process and provides a detailed discussion of the scientific soundness and policy importance of the 27 indicators as follows ...</LI></OL></P> <P><OL><LI>Ce rapport présente les recommandations consensuelles d’un groupe d’experts internationaux sur les indicateurs relatifs aux soins primaires et à la prévention. En suivant une méthodologie détaillée, le groupe d’experts a sélectionné 27 indicateurs devant couvrir les trois grands domaines suivants : la promotion de la santé, la prévention, le diagnostic et le traitement dans les soins primaires. Le rapport décrit la méthodologie employée et démontre, arguments à l’appui, la viabilité scientifique et l’importance stratégique des 27 indicateurs suivants ...</LI></OL></P> |
| Date: | 2004–10–28 |
| URL: | http://d.repec.org/n?u=RePEc:oec:elsaae:16-en&r=hea |
| By: | RICHARD HERMANN; SOEREN MATTKE |
| Abstract: | <P><OL><LI>This report presents the consensus recommendations of an international expert panel on indicators for mental health care. Using a structured review process, the panel selected a set of 12 indicators to cover the four key areas treatment, continuity of care, coordination of care, and patient outcomes. The report describes the review process and provides a detailed discussion of the scientific soundness and policy importance of the 12 indicators as follows ...</LI></OL></P> <P><OL><LI>Ce rapport présente les recommandations consensuelles d’un groupe d’experts internationaux sur les indicateurs relatifs aux soins de santé mentale. En suivant une méthodologie détaillée, le groupe d’experts a entrepris de sélectionner 12 indicateurs devant couvrir quatre grands domaines : le traitement, la continuité des soins, la coordination et les résultats. Le rapport décrit la méthodologie employée et démontre, arguments l’appui, la viabilité scientifique et l’importance stratégique des 12 indicateurs présentés ci-dessous ...</LI></OL></P> |
| Date: | 2004–10–28 |
| URL: | http://d.repec.org/n?u=RePEc:oec:elsaae:17-en&r=hea |
| By: | Charles L. Baum |
| Abstract: | Today, many pregnant women take a brief period of time off from work to give birth. In this paper, I identify the effects of pregnancy employment on health at birth. My initial results show that pregnancy employment has beneficial effects. However, these effects often become statistically insignificant when I control for earnings from pregnancy employment, when I exclusively examine women employed prior to the pregnancy, and when I examine siblings in fixed effects models. I conclude that beneficial effects of pregnancy employment are partially due to increased family income via earnings during the pregnancy and partially due to unobserved heterogeneity. There is no evidence that increased female labor force participation adversely affects health at birth. |
| Keywords: | Labor Supply; Pregnancy Employment; Health at Birth |
| JEL: | J1 J2 J3 |
| Date: | 2004–09 |
| URL: | http://d.repec.org/n?u=RePEc:mts:wpaper:200408&r=hea |