nep-hea New Economics Papers
on Health Economics
Issue of 2014‒03‒01
twenty-one papers chosen by
Yong Yin
SUNY at Buffalo

  1. Dealing with minor illnesses: the link between primary care characteristics and First Aid Clinics’ attendances By Donatini A.; Fiorentini G.; Lippi Bruni M.; Mammi I.; Ugolini C.
  2. “Create a Bigger Monster:†Tobacco industry actions to neutralize three landmark Surgeon Generals’ Reports By Klausner, Kim; Landman, Anne
  6. The economic behaviour of doctors: medical altruism without an ethic? By Philippe Batifoulier; Nicolas Da Silva
  7. Health Policy in Asia and the Pacific: Navigating Local Needs and Global Challenges By Kelley Lee
  8. Who Feels Inferior? A Test of the Status Anxiety Hypothesis of Social Inequalities in Health By Layte, Richard; Whelan, Christopher T.
  9. Neighborhood peer effects in the use of preventive health care By Nicolas BOUCKAERT
  10. The Effects of the Massachusetts Health Reform on Financial Distress By Mazumder, Bhashkar; Miller, Sarah
  11. Willingness-to-pay for road safety improvement By Mohamed Mouloud Haddak; Nathalie Havet; Marie Lefèvre
  12. What drives out-of pocket health expenditures of private households? - Empirical evidence from the Austrian household budget survey By Alice sanwald; Engelbert Theurl
  13. Discrimination Against The Obese And Very Thin Students In Brazilian Schools By Luis Claudio Kubota
  14. Education and Cancer Risk By Leuven, Edwin; Plug, Erik; Rønning, Marte
  15. The Impact of Eliminating a Child Benefit on Birth Timing and Infant Health By Borra, Cristina; Gonzalez, Libertad; Sevilla, Almudena
  16. Understanding Differences Between High- and Low-Price Hospitals: Implications for Efforts to Rein in Costs. By Chapin White; James D. Reschovsky; Amelia M. Bond
  17. Relaxing Occupational Licensing Requirements: Analyzing Wages and Prices for a Medical Service By Morris M. Kleiner; Allison Marier; Kyoung Won Park; Coady Wing
  18. Financial Incentives, Health and Retirement in Spain By Pilar García-Gómez; Sergi Jiménez-Martín; Judit Vall Castelló
  19. Adjusting Body Mass for Measurement Error with Invalid Validation Data By Charles Courtemanche; Joshua C. Pinkston; Jay Stewart
  20. Health Policy Model: Long-term Predictive Results Associated With The Management Of HCV-Induced Diseases In Italy By Francesco Saverio Mennini; Andrea Marcellusi; Massimo Andreoni; Antonio Gasbarrini; Salvatore Salomone; Antonio Craxì
  21. Should we call for a doctor? Households, consumption and the development of medical care in the Netherlands, 1650-1900 By Heidi Deneweth; Patrick Wallis

  1. By: Donatini A.; Fiorentini G.; Lippi Bruni M.; Mammi I.; Ugolini C.
    Abstract: The reformulation of existing boundaries between primary and secondary care, in order to shift selected services traditionally provided by Emergency Departments to community-based alternatives has determined a variety of organisational solutions aimed at reducing the ED overcrowding. One innovative change has been the introduction of fast-track systems for minor injuries or illnesses, whereby community care providers are involved in order to divert patients away from EDs. These facilities offer an open-access service for patients not requiring hospital treatments, and may be staffed by nurses and/or primary care general practitioners operating within, or alongside, the ED. To date little research has been undertaken on such experiences. To fill this gap, we analyse a First-aid clinic (FaC) in the Italian city of Parma, consisting of a minor injury unit located alongside the teaching hospital’s ED. We examine the link between the utilisation rates of the FaC and primary care characteristics, focusing on the main organisational features of the practices and estimating panel count data models for 2007-2010. Our main findings indicate that the younger cohorts are heavy users of the FaC and that the extension of practice opening hours significantly lowers the number of attendances, after controlling for GP’s and practice’s characteristics.
    JEL: I11 I18 C31
    Date: 2014–02
  2. By: Klausner, Kim; Landman, Anne
    Abstract: This paper was written for The Health Consequences of Smoking—50 Years of Progress. A Report of the Surgeon General.  Using documents from the Legacy Tobacco Documents Library ( it examines the tobacco industry’s response to three key Surgeon Generals’ reports that presented significant threats to its public image, sales and efficacy in litigation.  The research shows a determined industry effort to undermine the scientific evidence making up the reports, the conclusions of the reports, and the implications of the conclusions. The primary strategy was to refute, trivialize, and discredit the scientific evidence used in the reports and the processes used to reach conclusions.  The documents reviewed reveal additional tactics: an effort to claim that the Surgeon Generals’ reports are politically motivated, running paid ads that encourage people to doubt the Surgeon General’s conclusions, sending spokespersons around the country making statements in the media that conflict with the Surgeon General’s conclusions, and secretly funding independent groups whose sole purpose was to incite opposition to the Surgeon General’s conclusions. The documents show that such tactics have been centrally organized and orchestrated, and well-funded.
    Keywords: Business, Medicine and Health Sciences, Surgeon General; tobacco industry; junk science; smoking/history*; smoking/prevention & control
    Date: 2014–01–01
  3. By: Jean M. Abraham, Ph.D.; Roger Feldman, Ph.D.; Peter Graven, M.S.
    Abstract: Economic incentives such as the preferential tax treatment of premiums and economies of scale encourage employers to provide health insurance through the workplace. The employer’s decision to offer health insurance depends on how much workers value insurance relative to wages, and that value is likely to vary, given the composition of the establishment´s workforce. Using the 2008-2010 MEPS Insurance Component augmented with information from other data sources, we generate new estimates of employers’ price-sensitivity of offering insurance. Our results suggest that employers are sensitive to changes in the tax price of insurance, with very small employers exhibiting the largest price-sensitivity. Employer size, workforce composition, and local labor market conditions also influence the employer’s decision to offer insurance. New evidence can inform policy discussions about the implications of broad-based reforms that change marginal tax rates as well as targeted strategies that address the tax-exempt status of premiums.
    Date: 2014–01
  4. By: Jean M. Abraham, Ph.D.; Roger Feldman, Ph.D.; Peter Graven, M.S.
    Abstract: This study investigates how changes in the economic incentives created by the Affordable Care Act (ACA) will affect the probability that private-sector U.S. employers will offer health insurance. Using the Medical Expenditure Panel Survey Insurance Component for 2008-2010, we predict employers’ responses to key ACA provisions. Our simulations predict that overall demand for insurance will rise, driven by workers’ desire to avoid the individual mandate penalty and the availability of premium tax credits in exchanges. Our analyses also suggest that the average probability of an establishment offering insurance will decline from .83 to .66 with ACA implementation, although there is considerable variation by firm size, industry and union status.
    Keywords: health insurance, Affordable Care Act; premium tax credits; employer behavior
    JEL: I1 I13 J3
    Date: 2014–01
  5. By: Jonathan M. Lee; Laura O. Taylor
    Abstract: Compensating wages for workplace fatality and accident risks are used to infer the value of a statistical life (VSL), which in turn is used to assess the benefits of human health and safety regulations. The estimation of these wage differentials, however, has been plagued by measurement error and omitted variables. This paper employs the first quasi-experimental design within a labor market setting to overcome such limitations in the ex-tant literature. Specifically, randomly assigned, exogenous federal safety inspections are used to instrument for plant-level risks and combined with confidential U.S. Census data on manufacturing employment to estimate the VSL using a difference-in-differences framework. The VSL is estimated to be between $2 and $4 million ($2011), suggesting prior studies may substantially overstate the value workers place on safety, and therefore, the benefits of health and safety regulations.
    Keywords: value of a statistical life, hedonic wage models, OSHA, quasi-experiment
    JEL: Q58 J17 I18
    Date: 2014–01
  6. By: Philippe Batifoulier; Nicolas Da Silva
    Abstract: Health economics appears to have difficulty in taking medical ethics into consideration because of the standard figure of homo economicus. In main stream economics, the ethical attitude of a physician is then formalized in terms of “medical altruism”. This paper seeks to highlight the advantages and the contradictions of this medical altruism. We can identify several levels of problems raised by this medical altruism: theoretical paradoxes and economic policy problems for the regulator. The interest of the concept of medical altruism is to save or improve the economic theory with a more realistic assumption. However, if this assumption is more realistic, it induces paradoxes of economic theory. The misfortune for economists is that this theoretical inconstancy is lined with economic policy issues. These remain unresolved and we do not know what to do. In conclusion, we think that it becomes crucial to consider seriously medical ethics.
    Keywords: healthcare; altruism, professional ethics; instrumental rationality; intrinsic motivation
    JEL: B41 I10 I18
    Date: 2014
  7. By: Kelley Lee
    Abstract: Asia and the Pacific is undergoing a remarkable economic transformation, which is occurring at an exceptional pace. There is clear evidence of an equally rapid epidemiological transition in the region. This article sets out the policy challenges of building healthy societies in the context of rapid economic change. The region's location at the crossroads of contemporary globalisation, resulting in intensified population mobility, large-scale trade and investment, and pressures to take collective action on shared problems, adds to the complexity of this task. The article argues that health is integral to building stable and sustainable societies, and that there are opportunities to develop more holistic approaches that bring together hitherto separate policy spheres.
    Keywords: health policy; globalization; epidemiological transition; global governance; health care reform
  8. By: Layte, Richard; Whelan, Christopher T.
    Abstract: The empirical association between income inequality, population health and other social problems is now well established and the research literature suggests that the relationship is not artefactual. Debate is still ongoing as to the cause of this association. Wilkinson, Marmot and colleagues have argued for some time that the relationship stems from the psycho-social effects of status comparisons. Here, income inequality is a marker of a wider status hierarchy that provokes an emotional stress response in individuals that is harmful to health and well-being. We label this the 'status anxiety hypothesis'. If true, this would imply a structured relationship between income inequality at the societal level, individual income rank and anxiety relating to social status. This paper sets out strong and weak forms of the hypothesis and then presents three predictions concerning the structuring of 'status anxiety' at the individual level, given different levels of national income inequality and varying individual income. We then test these predictions using data from a cross-national survey of over 34,000 individuals carried out in 2007 in 31 European countries. Respondents from low inequality countries reported less status anxiety than those in higher inequality countries at all points on the income rank curve. This is an important precondition of support for the status anxiety hypothesis and may be seen as providing support for the weaker version of the hypothesis. However, we do not find evidence to support a stronger version of the hypothesis which we argue requires the negative effect of income rank on status anxiety to be exacerbated by increasing income inequality.
    Keywords: data/income inequality/Individuals/Inequality/population
    Date: 2014–01
  9. By: Nicolas BOUCKAERT
    Abstract: Individual participation in preventive care may depend on preventive health behavior in an individual’s peer group. This paper analyzes the importance of social interactions in the context of new social policies (PROGRESA) in Mexico that aim to increase the participation in different types of preventive care. We follow the promising approach of analyzing social interactions in real world peer groups. Identification of social interactions is based on a partial-population design. Results indicate that PROGRESA succeeded in increasing preventive care usage among program eligible households. In addition, endogenous social interactions increase preventive care usage both among eligibles and non-eligibles for various types of prevention. The overall treatment effect of PROGRESA on prevention can be decomposed in a direct effect related to financial incentives and an indirect effect related to social interactions. The indirect effect accounts for 10% up to 58% of the total treatment effect.
    Date: 2014–01
  10. By: Mazumder, Bhashkar (Federal Reserve Bank of Chicago); Miller, Sarah (University of Notre Dame)
    Abstract: A major benefit of health insurance coverage is that it protects the insured from unexpected medical costs that may devastate their personal finances. In this paper, we use detailed credit report information on a large panel of individuals to examine the effect of a major health care reform in Massachusetts in 2006 on a broad set of financial outcomes. The Massachusetts model served as the basis for the Affordable Care Act and allows us to examine the effect of coverage on financial outcomes for the entire population of the uninsured, not just those with very low incomes. We exploit plausibly exogenous variation in the impact of the reform across counties and age groups using levels of pre-reform insurance coverage as a measure of the potential effect of the reform. We find that the reform reduced the total amount of debt that was past due, the fraction of all debt that was past due, improved credit scores and reduced personal bankruptcies. We also find suggestive evidence that the reform lowered the total amount of debt and decreased third party collections. The effects are most pronounced for individuals who had limited access to credit markets before the reform. These results show that health care reform has implications that extend well beyond the health and health care utilization of those who gain insurance coverage.
    Keywords: Health care reform; health insurance; financial distress
    JEL: H75 I11 I13
    Date: 2014–01–23
  11. By: Mohamed Mouloud Haddak (IFSTTAR/UMRESTTE - Unité Mixte de Recherche Epidémiologique et de Surveillance Transport Travail Environnement - Université Claude Bernard - Lyon I - IFSTTAR); Nathalie Havet (GATE Lyon Saint-Étienne - Groupe d'analyse et de théorie économique - CNRS : UMR5824 - Université Lumière - Lyon II - École Normale Supérieure (ENS) - Lyon - PRES Université de Lyon - Université Jean Monnet - Saint-Etienne - Université Claude Bernard - Lyon I); Marie Lefèvre (IFSTTAR/UMRESTTE - Unité Mixte de Recherche Epidémiologique et de Surveillance Transport Travail Environnement - Université Claude Bernard - Lyon I - IFSTTAR)
    Abstract: Few studies have explored, to date, the issue of the monetary valuation of non-fatal injuries caused by road traffic accidents. The present paper arises interest in this question and aims to estimate, by means of the contingent valuation, the willingness to pay (WTP) of French households to improve their road safety level and reduce their risk of non-fatal injuries following a road accident. More precisely, Logit and Tobit models will be estimated to identify the factors influencing the individual will to pay. The results highlight the significant and positive influence of the injury severity on the WTP of the participants. The direct or indirect experience of road traffic accidents seems to play an important role and positively influences the valuation of the non-fatal injuries.
    Keywords: Road safety; Willingness to pay; Contingent valuation; Value of risk reduction; serious injuries
    Date: 2014–02–20
  12. By: Alice sanwald; Engelbert Theurl
    Abstract: Out-of-pocket health expenditures (OOPHE) are a substantial source of health care financing even in health care systems with an established role of prepaid financing. The empirical analysis of OOPHE is challenging, because they are fixed in an interaction with other sources of health care financing. We analyze to what extent a set of socio-economic and socio-demographic covariates of private households in influences the OOPHE-patterns in Austria. Our empirical research strategy is guided by the approach Propper (2000) used to study the demand for private health care in the NHS. We use cross-sectional information provided by the Austrian household budget survey 2009/10. We apply a Two-Part Model (Logit/OLS with log-transformed dependent variable or Logit/GLM). We present results for total OOPHE and for selected OOPHE-subcategories. Overall, we find mixed results for the different expenditure categories and for the two decision stages. Probability and level of OOPHE increase with the household size and the level of education, while household income shows mixed results on both stages. Private health insurance and OOPHE seem to be complements, at least for total OOPHE and for OOPHE for physician services, while this relationship is insignificant for pharmaceuticals. Different forms of public insurance have an effect on the total OOPHE-level, for physician services and pharmaceuticals on both stages. To some extent the participation decision is influenced in a different way compared to the intensity decision. This is especially true for age, sex, household structure and the status of retirement. It turns out, that the explanatory power of the used variables is low for OOPHE for pharmaceuticals. A splitting up of pharmaceuticals into prescription fees and direct payments gives better insights into the determinants. We conclude: It is necessary to investigate subcategories of OOPHE. It also turns out, that systematic covariates explain only a very small part of the variation in the OOPHE-patterns. Finally, we also conclude that information on OOPHE from general household budget surveys are of limited value when studying the determinants.
    Keywords: Health care expenditures, out-of-pocket health expenditures, consumer survey, Two-Part Model
    JEL: I1
    Date: 2014–02
  13. By: Luis Claudio Kubota
    Abstract: Pense 2012 is a survey conducted by the Brazilian Institute of Geography and Statistics (IBGE), in partnership with the Ministry of Health. PeNSE covers a broad range of subjects, especially risk behavior. This article has the aim of analyzing discrimination against obese and very thin students using PeNSE microdata. Data indicate that students that classify themselves as “very fat” or “very thin” are much more prone to risk zxbehaviors like consumption of illicit drugs, alcohol, cigarettes and laxatives (or vomit inducing), when compared to “normal” pupils. They are also much more likely to suffer from frequent bullying (FB), especially that motivated by their body appearance, to be active bullies, to feel frequently lonely, to suffer from insomnia, family violence, aggressions and injuries. A great percentage was involved in fights and feel that their parents rarely or never understand their problems and preoccupations. Econometric model shows that non “normal” students have a greater chance of suffering FB than “normal” pupils. Male students have greater chance of being frequently discriminated when compared to the female ones. There is no statistical difference between public and private schools. Black, yellow and Indian students have greater chance of suffering FB than white pupils. Students whose mothers didn’t study have greater chance of suffering FB than those whose mothers have completed high school education. A Pesquisa Nacional de Saúde do Escolar (PeNSE) 2012, realizada pelo Instituto Brasileiro de Geografia e Estatística (IBGE), em parceria com o Ministério da Saúde (MS), abrange um amplo leque de assuntos, com destaque para comportamentos de risco. Este artigo tem o objetivo de analisar a discriminação contra estudantes obesos e muito magros, utilizando microdados da Pe. Os dados indicam que alunos que se autoclassificam “muito gordos” ou “muito magros” são muito mais propensos a comportamentos de risco, como o consumo de drogas ilícitas, álcool, cigarros e laxantes (ou indução ao vômito), quando comparados com alunos “normais”. Eles também são muito mais sujeitos a sofrer bullying frequente (BF) – especialmente aquele motivado por sua aparência corporal, a serem bullies ativos, a sentirem solidão, a sofrerem de insônia, violência familiar, agressões e lesões. Um elevado percentual está envolvido em brigas e avalia que seus pais raramente ou nunca entendem seus problemas e preocupações. O modelo econométrico implementado mostra que estudantes não “normais” têm mais chance de sofrer BF que os “normais”. Os alunos do sexo masculino têm maior chance de ser discriminados em relação às alunas. Não há diferença estatisticamente significativa entre escolas públicas e privadas. Alunos pretos, amarelos e indígenas têm maior chance de sofrer BF em relação aos brancos. Estudantes cujas mães não estudaram têm maior chance de sofrer BF em relação àqueles cujas mães têm ensino médio completo.
    Date: 2014–01
  14. By: Leuven, Edwin (University of Oslo); Plug, Erik (University of Amsterdam); Rønning, Marte (Statistics Norway)
    Abstract: There exists a strong educational gradient in cancer risk, which has been documented in a wide range of populations. Yet relatively little is known about the extent to which education is causally linked to cancer incidence and mortality. This paper exploits a large social experiment where an education reform expanded compulsory schooling during the 1960s in Norway. The reform led to a discontinuous increase in educational attainment, which we exploit to estimate the effect of the reform on various cancer outcomes. Our main finding is that education has little if any impact on cancer risk. This holds for all cancer sites together as well as the most common cancer sites in isolation, with two exceptions. The compulsory school reform lowered the risk of lung cancer for men, but increased the risk of colorectal cancer for women.
    Keywords: education, causality, health, cancer
    JEL: I12 I21
    Date: 2014–02
  15. By: Borra, Cristina (University of Seville); Gonzalez, Libertad (Universitat Pompeu Fabra); Sevilla, Almudena (Queen Mary, University of London)
    Abstract: We study the effects of the cancellation of a sizeable child benefit in Spain on birth timing and neonatal health. In May 2010, the government announced that a 2,500-euro universal "baby bonus" would stop being paid to babies born on or after January 1st, 2011. We use detailed micro data from birth certificates from 2000 to 2011, and find that more than 2,000 families were able to anticipate the date of birth of their babies from (early) January 2011 to (late) December 2010 (for a total of about 9,000 births a week nationally). This shifting of deliveries led to a significant increase in the number of low birth weight babies, as well as a peak in neonatal mortality. These results suggest that announcement effects are important in shaping economic decisions and outcomes. They also provide new, credible evidence highlighting the negative health consequences of scheduling births for non-medical reasons.
    Keywords: incentives, policy change, fertility, child health
    JEL: H00 H30 J00 J13 J17
    Date: 2014–02
  16. By: Chapin White; James D. Reschovsky; Amelia M. Bond
    Abstract: A study examining the relationship between hospital characteristics and hospital prices can help inform the debate on controlling health care costs. Compared to other hospitals, high-price hospitals tend to be larger, be major teaching hospitals, belong to systems with large market shares, provide specialized services, and receive significant revenues from nonpatient sources. However, quality indicators for high-price hospitals were mixed. Although these hospitals fared better than other hospitals on U.S. News & World Report rankings, which are largely based on reputation, they generally scored worse on objective measures of quality, such as postsurgical mortality rates.
    Keywords: Hospitals, Health Economics, Cost of Healthcare
    JEL: I
    Date: 2014–02–01
  17. By: Morris M. Kleiner; Allison Marier; Kyoung Won Park; Coady Wing
    Abstract: Occupational licensing laws have been relaxed in a large number of U.S. states to give nurse practitioners the ability to perform more tasks without the supervision of medical doctors. We investigate how these regulations may affect wages, employment, costs, and quality of providing certain types of medical services. We find that when only physicians are allowed to prescribe controlled substances that this is associated with a reduction in nurse practitioner wages, and increases in physician wages suggesting some substitution among these occupations. Furthermore, our estimates show that prescription restrictions lead to a reduction in hours worked by nurse practitioners and are associated with increases in physician hours worked. Our analysis of insurance claims data shows that the more rigid regulations increase the price of a well-child medical exam by 3 to 16 %. However, our analysis finds no evidence that the changes in regulatory policy are reflected in outcomes such as infant mortality rates or malpractice premiums. Overall, our results suggest that these more restrictive state licensing practices are associated with changes in wages and employment patterns, and also increase the costs of routine medical care, but do not seem to influence health care quality.
    JEL: D02 D42 H7 I1 I12 I18 I28 J0 J18
    Date: 2014–02
  18. By: Pilar García-Gómez; Sergi Jiménez-Martín; Judit Vall Castelló
    Abstract: In this work we combine wage data from Social Security working histories and health information available in the Survey of Health and Retirement in Europe to explore the link between health, financial incentives and retirement in Spain. Our results show that individuals in worse health quintiles are, indeed, the more responsive to financial incentives as they prove to be less likely to retire when incentives to continue working increase.
    JEL: H55 I18 J11
    Date: 2014–02
  19. By: Charles Courtemanche; Joshua C. Pinkston; Jay Stewart
    Abstract: We propose a new method for using validation data to correct self-reported weight and height in surveys that do not weigh and measure respondents. The standard correction from prior research regresses actual measures on reported values using an external validation dataset, and then uses the estimated coefficients to predict actual measures in the primary dataset. This approach requires the strong assumption that the expectations of actual weight and height conditional on the reported values are the same in both datasets. In contrast, we use percentile ranks rather than levels of reported weight and height. Our approach requires the much weaker assumption that the conditional expectations of actual measures are increasing in reported values in both samples, making our correction more robust to differences in measurement error across surveys. We then examine three nationally representative datasets and confirm that misreporting is sensitive to differences in survey context such as data collection mode. When we compare predicted BMI distributions using the two approaches, we find that the standard correction is biased by differences in misreporting while our correction is not. Finally, we present several examples that demonstrate the potential importance of our correction for future econometric analyses and estimates of obesity rates.
    JEL: C18 I1
    Date: 2014–02
  20. By: Francesco Saverio Mennini (CEIS University of Rome "Tor Vergata"); Andrea Marcellusi (CEIS University of Rome "Tor Vergata"); Massimo Andreoni (School of Medicine, University of Rome Tor Vergata, Rome); Antonio Gasbarrini (Catholic University of the Sacred Heart of Rome); Salvatore Salomone (University of Catania); Antonio Craxì (University of Palermo)
    Abstract: Background: This study is aimed at describing the epidemiological and economic burden that HCV will generate in the next few years in Italy. Furthermore, the impact that future anti-HCV treatments may have on the burden of disease was considered. The analysis has been developed over the period 2013-2030 from the Italian National Health Service (NHS) perspective. Methods: A published system dynamic model was adapted for Italy in order to quantify the HCV-infected population, the disease progression and the associated cost from 1950 to 2030. The model structure was based on transition probabilities reflecting the natural history of the disease. In order to estimate the efficacy of current anti-HCV treatment strategies for different Genotypes, it was estimated the sustained virological response (SVR) rate in registration clinical trials for both Boceprevir and Telaprevir. It was assumed that the efficacy for patients treated with peginterferon+ribavirin was equal to the placebo arm of randomized clinical trial (RCT) relating to Boceprevir and Telaprevir. According to the aim of the study, only direct healthcare costs (hospital admissions, drugs, treatment and care of patients) incurred by the Italian NHS have been included in the model. Costs have been extrapolated by the published scientific literature available in Italy and actualized at 2011 ISTAT Price Index system for monetary revaluation. Three different scenario was assumed in order to evaluate the impact of future anti-HCV treatments may have on the burden of disease. Results: Overall, in Italy 1.2 million infected subjects were estimated in 2012. Out of these, about 211 thousand patients were diagnosed, while about 11,800 subjects are actually being treated with anti-HCV drugs. A reduction of healthcare costs is associated with a prevalence decrease. Indeed, once the spending peak is reached during this decade (about € 527 million), the model predicts a cost reduction in the following 18 years. In 2030, due to the more effective treatments currently available, the direct healthcare cost associated with the management of HCV patients HCV may reach € 346 million (-34.3% compared to 2012). The first scenario (new treatment in 2015 with SVR = 90% and same number of treated patients) was associated with a significant reduction in HCV-induced clinical consequences (prevalence = -3%) and a decrease in healthcare direct expenses corresponding to € 11.1 million. The second scenario (increasing treated patients until 12,790) produced an incremental cost reduction of € 7.3 million, reaching a net decrease equal to € 18.4 million. In the third scenario (treated patients = 16,770), a higher net healthcare direct cost decrease vs the base-case (€ 44.0 million ) was estimated. Conclusions: This study does not have the pretension of being or creating a model of epidemiological projection. Its primary objective is to supply data and a careful consideration for a encourage dialogue among the different professionals fully involved in the management of patients with HCV-induced chronic infection, and to suggest a valuable tool for future health policy strategy. Running head: Long-term predictive HCV-induced diseases cost in Italy
    Keywords: Cost of Illness, Chronic Hepatitis, Forecast, New HCV treatment
    JEL: H68
    Date: 2014–02–17
  21. By: Heidi Deneweth; Patrick Wallis
    Abstract: This article examines the Dutch medical marketplace between 1650 and 1900 from a household’s perspective, based on the probate inventories database of the Meertens Institute. It offers the first quantitative analysis of demand for medical care in small towns and villages across the Netherlands. Our findings offer a substantial contrast to the well-known medical market in the Netherland’s major cities and might be more representative for general European patterns. We observe that different usage of medical care bears similarity to the households’ income, level of monetisation and engagement in commercial activities and other forms of non-essential consumption. While the pre-industrial era showed very outspoken differences in medical consumption between the commercialised maritime part of the Netherlands and the more autarchic inland region, patterns of medical consumption converged during the nineteenth century. These findings suggest that demand set a basic boundary for the further development of medical supply.
    Keywords: Medical market, Household economics, The Netherlands, 17th-19th centuries
    Date: 2014–02

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