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on Health Economics |
| By: | Ellen P. Green (Department of Economics,University of Delaware) |
| Abstract: | Policy makers and the healthcare industry have proposed changes to physician payment structures as a way to improve the quality of health care and reduce costs. Several of these proposals require healthcare providers to employ a valuebased purchasing program (also known as pay-for-performance [P4P]). However, the way in which existing payment structures impact physician behavior is unclear and, therefore, predicting how well P4P will perform is difficult. To understand the impact physician payment structures have on physician behavior, I approximate the physician-patient relationship in a real-effort laboratory experiment. I study several prominent physician payment structures including feefor- service, capitation, salary, and P4P. I find that physicians are intrinsically motivated to provide high quality care and relying exclusively on extrinsic incentives to motivate physicians is detrimental to the quality of care and costly for the healthcare industry. |
| Keywords: | Physician Payment System, Laboratory Experiment, Incentives, Fee-for-Service, Capitation, Salary, Report Cards, Pay-for-Performance, Crowd Out |
| JEL: | C9 I1 |
| Date: | 2013 |
| URL: | http://d.repec.org/n?u=RePEc:dlw:wpaper:13-05.&r=hea |
| By: | Wren, Maev-Ann; Kelly, Peter |
| Abstract: | This paper assesses the validity of estimating stroke incidence employing discharge data from the Hospital Inpatient Enquiry (HIPE) database, adjusted to reflect evidence from the North Dublin Population Stroke Study (NDPSS). This analysis compares contemporaneous HIPE stroke discharges among North Dublin residents to hospitalised stroke patients in the NDPSS and finds no significant difference between the datasets' measures of hospitalised stroke cases in five North Dublin hospitals. We find that in estimating incidence, HIPE discharges with principal and secondary stroke diagnoses should be included but patients admitted for rehabilitation should be excluded to avoid duplication. The HIPE-based estimate should be further adjusted to reflect the NDPSS evidence of non-hospitalised stroke incidents. |
| Keywords: | Ireland/stroke/data/population |
| Date: | 2013–10 |
| URL: | http://d.repec.org/n?u=RePEc:esr:wpaper:wp469&r=hea |
| By: | Georges KONE (IRD - Institut de Recherche pour le Développement - Institut de Recherche pour le Développement); Richard Lalou (IRD - Institut de Recherche pour le Développement - Institut de Recherche pour le Développement); Martine Audibert (CERDI - Centre d'études et de recherches sur le developpement international - CNRS : UMR6587 - Université d'Auvergne - Clermont-Ferrand I); Hervé LAFARGE (University Paris Dauphine - University Paris Dauphine - University Paris Dauphine); Stéphanie Dos Santos (IRD - Institut de Recherche pour le Développement - Institut de Recherche pour le Développement); Jean-Yves Le Hesran (IRD - Institut de Recherche pour le Développement - Institut de Recherche pour le Développement) |
| Abstract: | The aim of this paper is to evaluate the relative influence of neighbourhood and individual practices of care utilization in Dakar (Senegal). The data from a research program on urban malaria, made in Dakar, Senegal between 2008 and 2009. The sample was based on a two-stage sampling. A questionnaire survey covered 2952 households, of which we have selected those that have at least one case of fever (n = 1272) with one of their children under ten years two weeks before the passage of investigators. The analytical model of the use of health services developed by R. Andersen has been adapted for our conceptual framework. Our results showed's like many West African cities, self-medication is a common practice among all households in Dakar, especially the poorest. The non-use of health services is positively associated with individual characteristics such as education level, the level of social network and the level of health literacy of the mother / guardian of the sick child (p |
| Keywords: | dakar;malaria;access to health care;Poverty;neighborhoods;equity |
| Date: | 2013–10–31 |
| URL: | http://d.repec.org/n?u=RePEc:hal:wpaper:halshs-00878946&r=hea |
| By: | Anusua Datta; Dhaval M. Dave |
| Abstract: | Spending on prescription drugs (Rx) represents one of the fastest growing components of U.S. healthcare spending, and has coincided with an expansion of pharmaceutical promotional spending. Most (83%) of Rx promotion is directed at physicians in the form of visits by pharmaceutical representatives (known as detailing) and drug samples provided to physicians’ offices. Such promotion has come under increased public scrutiny, with critics contending that physician-directed promotion may play a role in raising healthcare costs and may unduly affect physicians’ prescribing habits towards more expensive, and possibly less cost-effective, drugs. In this study, we bring longitudinal evidence to bear upon the question of how detailing impacts physicians’ prescribing behaviors. Specifically, we examine prescriptions and promotion for a particular drug class based on a nationally-representative sample of 150,000 physicians spanning 24 months. The use of longitudinal physician-level data allows us to tackle some of the empirical concerns in the extant literature, virtually all of which has relied on aggregate national data. We estimate fixed-effects specifications that bypass stable unobserved physician-specific heterogeneity and address potential targeting bias. In addition, we also assess differential effects at both the extensive and intensive margins of prescribing behaviors, and differential effects across physician- and market-level characteristics, questions which have not been explored in prior work. The estimates suggest that detailing has a significant and positive effect on the number of new scripts written for the detailed drug, with an elasticity magnitude of 0.06. This effect is substantially smaller than those in the literature based on aggregate information, suggesting that most of the observed relationship between physician-directed promotion and drug sales is driven by selection bias. Qualitatively consistent with the literature, we find that detailing impacts selective brand-specific demand but does not have any substantial effects on class-level demand. Results also indicate that most of the detailing response may operate at the extensive margin; detailing affects the probability of prescribing the drug more than it affects the number of prescriptions conditional on any prescribing. We draw some implications from these estimates with respect to effects on healthcare costs and public health. |
| JEL: | D22 I0 M3 |
| Date: | 2013–11 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:19592&r=hea |
| By: | Perianayagam , Arokiasamy; Goli, Srinivas |
| Abstract: | India’s health care and health financing provision is characterized by too little Government spending on health, meager health insurance coverage, declining public health care use contrasted by highest levels of private out-of-pocket health spending in the world. To understand the interconnectedness of these disturbing outcomes, this paper envisions a theoretical framework of health insurance and health care revisits the existing health insurance schemes and assesses the health insurance cover in relation to the pattern of health care use using data from myriad official statistics and the recent NFHS, 2005-06. Theoretical exploration of the axis of supply-demand determinants unfolds that a complex of factors such as sparse health financing options, self-obstructing heavily risk protected insurance market and weak consumer demand contribute to the measly level of health insurance penetration in India. Health insurance cover is found to be a strong determinant of modern health care use. Regional and rural-urban disparities in health insurance and health care are significant. Health insurance coverage is positively related while public health care use is negatively related with household economic condition and education status. The complex axis of critical supply side imperfections and considerable demand side weaknesses necessitate a major health care reform with the viable financing and health care options. |
| Keywords: | Health insurance, health care, supply-demand perspective, India |
| JEL: | I11 I13 I14 I18 |
| Date: | 2013–10–31 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:51103&r=hea |