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Biomedical subjects

C E Phelps

Publications and source records attributed to C E Phelps.

At least 37 records · Page 2Linked to original sources
PubMed1988

Caffeine ingestion and breast cancer. A negative correlation.

The potential association of breast cancer and caffeine intake was examined using international aggregate data. Death rates from breast cancer were correlated with caffeine ingestion from tea and coffee sources in 44 countries. By using multiple regression analysis, the authors demonstrated that 85% of the international variation in breast cancer rates is associated with variations in fat intake. When this is accounted for, the partial correlation of breast cancer rates with caffeine intake is negative (and significant at P less than 0.05). When the data are weighted by populations in each country, the negative partial correlation of caffeine with breast cancer disappears, but the strong positive association with fat intake remains unchanged. Although there have been suggestions that caffeine exacerbates fibrocystic disease of the breast and may be a causal factor in breast cancer, data from this study do not support a positive association between caffeine intake and subsequent development of breast cancer.

Breast Neoplasms↗
PubMed1988

Death and taxes. An opportunity for substitution.

The risks of fatal vehicle crash for young drivers rise precipitously with more drinking, reaching a 100-fold increase in risk for youths with 6+ drinks. Considerable external damage arises from drunk driving, providing firm logic for government intervention. If the 'cost' of an alcohol tax is the foregone consumer surplus of drinkers, then the cost per life saved using higher alcohol taxes is less than +10,000 per life at low taxes, even ignoring the lives of the drinking drivers. Thus, alcohol taxes are one of the cheapest possible life saving techniques available. Preliminary evidence suggests that youthful drinking drivers badly under-perceive the risks of their own behavior. This increases the measure of 'external damage' and hence the optimal tax for alcoholic beverages. It may be impossible to administer an 'optimal tax' on alcohol, but 'second-best' taxes appear to lie in the range of 25 to 40 percent or more.

Accidents, Traffic↗
PubMed1987

Price elasticity and adverse selection in the demand for supplementary health insurance.

Probit regression estimates show the effects of the price of insurance, anticipated medical expenditures, and other factors on reported decisions about purchasing hypothetically offered supplementary insurance policies. The demand estimates can characterize how much supplemental insurance would be purchased under different tax policies affecting health insurance purchases. Although eliminating the current tax subsidy to insurance is shown to decrease demand, the results indicate a substantial demand for supplementary insurance even in the absence of present tax incentives. However, our results on adverse selection raise concerns about the potential stability of supplemental insurance markets.

Algorithms↗
PubMed1984

Adoption and diffusion of a new imaging technology: a magnetic resonance imaging prospective.

Adoption of magnetic resonance imaging (MRI) by individual purchasers and by the health care system will be influenced by many factors. A framework for considering these influences is offered, incorporating them into four major considerations: (1) MRI and its attributes--the technology, its safety and efficacy, and the benefits of acquisition; (2) communication channels--commercial and professional; (3) time for consideration of adoption and experiential testing; and (4) the medical system--including potential acquirers, health planning, and reimbursement. Among these, positive, negative, and variable influences affecting adoption can be identified. Factors that should most strongly motivate early adoption are the potential of the technology for providing new and useful clinical information and the competitive and economic benefits that early acquirers might enjoy. Important discouragements include the possibility of early obsolescence and that MRI represents an economic risk under diagnostic-related-group reimbursement. The less risky approach for most practices is to delay acquisition of MRI pending further experience with the technology and the changing reimbursement climate. Institutions that are primarily interested in the research potential of MRI or that are large enough to sustain the economic risks should consider earlier acquisition.

Health Planning↗
PubMed1981

Some interim results from a controlled trial of cost sharing in health insurance.

A total of 7706 persons are participating in a controlled trial of alternative health-insurance policies. Interim results indicate that persons fully covered for medical services spend about 50 per cent more than do similar persons with income-related catastrophe insurance. Full coverage leads to more people using services and to more services per user. Both ambulatory services and hospital admissions increase. Once patients are admitted to the hospital, however, expenditures per admission do not differ significantly among the experimental insurance plans. In addition, hospital admissions for children do not vary by plan. The income-related cost sharing in the experimental plans affects expenditure by different income groups similarly, but adults' total expenditure varies more than children's. Sufficient data are not available on whether higher use by persons with free care reflects overuse, or whether lower use by those with income-related catastrophe coverage reflects underuse. Both may well be true.

Ambulatory Care↗
PubMed1978

Illness prevention and medical insurance.

A theory of demand for preventive medical services is developed from a model of an expected-ultility-maximizing consumer. Preventive medical care is said to alter the probabilities of illness as well as the final health outcome in sick states. The value of preventive medical care depends upon pure health gains (which directly increase utility), work-loss-time avoided, and out-of-pocket medical expenses avoided. Studies cited from the literature show that many commonly accepted screening procedures have no observable payoff in health status or medical expenses saved. In stark contrast, personal behavioral decisions, such as smoking and dietary patterns, appear to have dramatic effects on health and mortality. Public policy appears to be better directed toward inducement of such health-producing behavior than inducement of further medical preventive procedures.

Health↗
PubMedDate not supplied

Perspectives in health economics.

This paper, originally presented at the Institute d'Etudes Politiques de Paris, October 12, 1993, provides a perspective on envisioned changes in the practice of health economics. Foreseen changes include: (1) Study of more homogeneous units of analysis; (2) More original data gathering; (3) Increased attention to uncertainty and the supply of and demand for information; (4) Increased attention to institutional structures and their effects on economic behaviour; (5) Expansion of relevant tools for studying economic issues in health care; and (6) Continuing breakdown of disciplinary barriers between health economics and other disciplines. Of these, the two overriding features will be increased emphasis on understanding the many roles of uncertainty in economic behaviour, institutions, and outcomes in health care, and in the use of more and more 'micro' data to study these issues.

Data Collection↗
PubMedDate not supplied

Focusing technology assessment using medical decision theory.

Combining medical decision theory and epidemiologic information, the authors have developed a strategy to assess diagnostic technologies. For any patient, patient utilities with new diagnostic information are compared with the preferred fallback action absent that diagnostic information. After determination of whether the expected value of diagnostic information (EVDI) justifies its cost, the method adds across the eligible population to determine whether the global EVDI justifies the technology's deployment, employing a screen (Hurdle 1) that assumes that the diagnostic device has perfect accuracy. This preliminary evaluation relies on published data on treatment efficacy, population probabilities of illness, etc., but not on new clinical trials. If the technology is not sufficiently cost-effective, even with this optimistic assumption, the strategy recommends against its use. Otherwise, the next step is Hurdle II, in which the critical clinical studies, identified by the decision-theory model, are undertaken. These commonly include measuring the actual diagnostic accuracy of a device, with which the cost-effectiveness is recalculated. These studies in general do not require randomized controlled trials.

Algorithms↗
PubMedDate not supplied

Targeting assessments of magnetic resonance imaging in suspected multiple sclerosis.

Decision-analytic methods can be valuable for targeting research in technology assessment. They can indicate whether further evaluation of a technology is warranted, and if so, which variables are key determinants of its clinical utility and cost-effectiveness. This approach was tested on a salient issue--whether magnetic resonance imaging (MR) should be used in evaluating patients with mild neurologic symptoms who might have multiple sclerosis (MS). The authors developed a decision-analytic model to assess the expected utility and costs associated with immediately using MR in this situation, compared with waiting for further symptoms to emerge before testing. Sensitivity analyses demonstrated that priorities for technology assessment research include estimating the value of information to patients in resolving uncertainty, evaluating the impact on patients of being labeled with a diagnosis of MS, and measuring the test characteristics of MR.

Adult↗