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Biomedical subjects

E van Doorslaer

Publications and source records attributed to E van Doorslaer.

At least 19 recordsLinked to original sources
PubMed2000

Equity in the delivery of health care in Europe and the US.

This paper presents a comparison of horizontal equity in health care utilization in 10 European countries and the US. It does not only extend previous work by using more recent data from a larger set of countries, but also uses new methods and presents disaggregated results by various types of care. In all countries, the lower-income groups are more intensive users of the health care system. But after indirect standardization for need differences, there is little or no evidence of significant inequity in the delivery of health care overall, though in half of the countries, significant pro-rich inequity emerges for physician contacts. This seems to be due mainly to a higher use of medical specialist services by higher-income groups and a higher use of GP care among lower-income groups. These findings appear to be fairly general and emerge in countries with very diverse characteristics regarding access and provider incentives.

Data Collection↗
PubMed2000

Income-related health inequality in Canada.

This study uses data from the 1994 National Population Health Survey and applies the methods developed by Wagstaff and van Doorslaer (1994, measuring inequalities in health in the presence of multiple-category morbidity indicators. Health Economics 3, 281-291) to measure the degree of income-related inequality in self-reported health in Canada by means of concentration indices. It finds that significant inequalities in self-reported ill-health exist and favour the higher income groups--the higher the level of income, the better the level of self-assessed health. The analysis also indicates that lower income individuals are somewhat more likely to report their self-assessed health as poor or less-than-good than higher income groups, at the same level of a more 'objective' health indictor such as the McMaster Health Utility Index. The degree of inequality in 'subjective' health is slightly higher than in 'objective' health, but not significantly different. The degree of inequality in self-assessed health in Canada was found to be significantly higher than that reported by van Doorslaer et al. (1997, income related inequalities in health: some international comparisons, Journal of Health Economics 16, 93-112) for seven European countries, but not significantly different from the health inequality measured for the UK or the US. It also appears as if Canada's health inequality is higher than what would be expected on the basis of its income inequality.

Canada↗
PubMed2000

Income inequality and health: what does the literature tell us?

This paper reviews the large and growing body of literature on the apparently negative effects of income inequality on population health. Various hypotheses are identified and described that explain the empirically observed association between measures of income inequality and population health. We have concluded that data from aggregate-level studies of the effect of income inequality on health, i.e. studies at the population and community (e.g. state) levels, are largely insufficient to discriminate between competing hypotheses. Only individual-level studies have the potential to discriminate between most of the advanced hypotheses. The relevant individual-level studies to date, all on U.S. population data, provide strong support for the "absolute-income hypothesis," no support for the "relative-income hypothesis," and little or no support for the "income-inequality hypothesis." Results that provide some support for the income-inequality hypothesis suggest that income inequality at the state level affects mainly the health of the poor. There is only indirect evidence for the "deprivation hypothesis," and no evidence supports the "relative-position hypothesis." Overall, the absolute-income hypothesis, although > 20 years old, is still the most likely to explain the frequently observed strong association between population health and income inequality levels.

Evidence-Based Medicine↗
PubMed1999

The redistributive effect of health care finance in twelve OECD countries.

The OECD countries finance their health care through a mixture of taxes, social insurance contributions, private insurance premiums and out-of-pocket payments. The various payment sources have very different implications for both vertical and horizontal equity and on redistributive effect which is a function of both. This paper presents results on the income redistribution consequences of the health care financing mixes adopted in twelve OECD countries by decomposing the overall income redistributive effect into a progressivity, horizontal inequity and reranking component. The general finding of this study is that the vertical effect is much more important than horizontal inequity and reranking in determining the overall redistributive effect but that their relative importance varies by source of payment. Public finance sources tend to have small positive redistributive effects and less differential treatment while private financing sources generally have (larger) negative redistributive effects which are to a substantial degree caused by differential treatment.

Cross-Cultural Comparison↗
PubMed1999

Equity in the finance of health care: some further international comparisons.

This paper presents further international comparisons of progressivity of health care financing systems. The paper builds on the work of Wagstaff et al. [Wagstaff, A., van Doorslaer E., et al., 1992. Equity in the finance of health care: some international comparisons, Journal of Health Economics 11, pp. 361-387] but extends it in a number of directions: we modify the methodology used there and achieve a higher degree of cross-country comparability in variable definitions; we update and extend the cross-section of countries; and we present evidence on trends in financing mixes and progressivity.

Cross-Cultural Comparison↗
PubMed1998

An economic evaluation of hepatitis A vaccination in Dutch military personnel.

We analyzed the cost-effectiveness of hepatitis A vaccination regimens using a mathematical simulation model. Passive immunization and two active vaccination strategies (with and without prior screening) were compared with "doing nothing." Hepatitis A antibodies were determined in 2,325 Dutch marines; other input data were retrieved from published and unpublished sources. The prevalence of hepatitis A antibody was 14%. Screening before vaccination was identified as appropriate at a prevalence > 20%. Passive immunization was the cheapest prevention for a single 6-month deployment per 10 years. The inactivated vaccine containing 1,440 enzyme-linked immunosorbent assay units without prior screening was identified as the best option for more frequent deployments. It was cost-saving with two or more missions per 10 years. A 5.3% hepatitis A attack rate validated the investment for this policy. Overall, immunization with inactivated hepatitis A vaccine without prior screening proved to be the optimum strategy for troops at regular risk.

Adolescent↗
PubMed1997

Income-related inequalities in health: some international comparisons.

This paper presents evidence on income-related inequalities in self-assessed health in nine industrialized countries. Health interview survey data were used to construct concentration curves of self-assessed health, measured as a latent variable. Inequalities in health favoured the higher income groups and were statistically significant in all countries. Inequalities were particularly high in the United States and the United Kingdom. Amongst other European countries, Sweden, Finland and the former East Germany had the lowest inequality. Across countries, a strong association was found between inequalities in health and inequalities in income.

Developed Countries↗
PubMed1997

Progressivity, horizontal equity and reranking in health care finance: a decomposition analysis for The Netherlands.

This paper employs the method of Aronson et al. (1994) to decompose the redistributive effect of the Dutch health care financing system into three components: a progressivity component, a classical horizontal equity component and a reranking component. Results are presented for the health care financing system as a whole, as well as for its constituent parts. A final section sets out to uncover the relative importance (in terms of their effects on progressivity, horizontal equity and reranking) of the key institutional features of one component of the Dutch system-the AWBZ social insurance scheme.

European Union↗
PubMed1995

Patient utilities in fibromyalgia and the association with other outcome measures.

OBJECTIVE: To compare in patients with fibromyalgia (FM) utilities derived by rating scale and standard gamble methods; to gain insight into construct validity by relating utility values to other outcome measures; to assess the sensitivity to change of utilities. METHODS: A total of 73 patients with FM were randomized into one of 3 groups: low impact fitness training, biofeedback, or controls. At baseline and after 6 mo the Maastricht Utility Measurement Questionnaire was applied. By means of both the rating scale and standard gamble method patients were asked to value their own health status. Construct validity of patient utility measurements was evaluated by Spearman correlation and multiple regression of baseline values with pain, stiffness, patient's global assessment, Sickness Impact Profile (SIP), modified Health Assessment Questionnaire and Arthritis Impact Measurement Scale (AIMS). Sensitivity to change was assessed against changes in these outcomes. RESULTS: Rating scale utilities correlated significantly (p < 0.05) with patient's global assessment (rs = 0.53), pain (rs = -0.47), SIP (rs = -0.43), and with 9 of 11 dimensions of the AIMS (rs ranging from 0.23 to 0.62). Standard gamble utilities correlated significantly with mobility, pain, and arthritis impact of the AIMS scale (rs from 0.22 to 0.36) and with pain by visual analog scale (rs = -0.24) and patient's global assessment (rs = 0.32). Multiple regression analysis showed that patient's global assessment explained 41% (rating scale) and 10% (standard gamble) of total variance in baseline utilities. Also, 16% of the variance in change in rating scale utility values was explained by changes in patient's global assessment. In contrast, variance of changes in standard gamble utility values was not explained significantly by changes in other disease outcomes. CONCLUSION: Rating scale utilities correlated more strongly with disease outcome measures than standard gamble utilities. Also, construct validity for the rating scale was better than for the standard gamble. In FM, utility measurement is sensitive to the method chosen to elicit patient priorities.

Adolescent↗
PubMed1994

The role of the sickness funds in the Belgian health care market.

This article reviews some of the salient features of the Belgian health care finance and delivery system. Special attention is paid to the role played by the third-party payers, i.e. the Health Insurance Associations (HIAs) in administering the compulsory national health insurance program. It is shown how, despite extensive government regulation, the markets for GP, specialist and hospital services exhibit fierce competition of the non-price variety. Next, the paper considers the three problems perceived to be the most pressing ones at present: (i) the problem of raising sufficient revenues to cover the public share of health expenditures; (ii) the (related) cost containment problem; and (iii) the problem of ensuring efficiency through appropriate incentive mechanisms. Finally, two recently proposed options for reform are discussed and complemented with a third proposal based on the ideas of regulated competition. It is concluded that strengthening the role of the third-party payers remains crucial in any attempt to reshape the system to make it efficient and affordable while keeping it equitable.

Belgium↗
PubMed1994

Patient utilities in ankylosing spondylitis and the association with other outcome measures.

OBJECTIVE: To compare in patients with ankylosing spondylitis (AS) utilities derived by rating scale and standard gamble method, to relate these values to other outcome measures, and to assess the sensitivity to change of utilities relative to changes in other outcomes. METHODS: Patients with AS were randomly allocated to either weekly sessions of supervised group physical therapy for a period of 9 months or daily exercises at home. Analysis was restricted to the 59 patients who completed the Maastricht Utility Measurement Questionnaire (MUMQ) at baseline and after 9 months' followup and who were seen by the same interviewer. Reliability was assessed by intraclass correlation coefficient and change scores for marker states of disease. Construct validity was evaluated by correlation and multiple regression of baseline values with a variety of disease outcomes (pain and stiffness, patient's and physician's global assessment, Sickness Impact Profile, Health Assessment Questionnaire for the Spondyloarthropathies, Arthritis Impact Measurement Scale, functional, articular, and enthesis indices and spinal mobility measures). Sensitivity to change was assessed against changes in these outcome measures at followup. RESULTS: The test-retest intraclass correlation coefficients for patient utilities were 0.95 (rating scale) and 0.79 (standard gamble), and for the marker state of mild disease 0.70 (rating scale) and 0.77 (standard gamble). A multiple regression analysis with the baseline rating scale or standard gamble utilities as dependent variable showed that patient's global assessment explained 59 and 11% of the total variance respectively. By multiple regression analysis 10% of the variance of change in rating scale utilities was explained by changes of patient's global assessment. In contrast, variance in change in standard gamble utilities was not explained by changes in other disease outcomes. CONCLUSION: Findings obtained by rating scale and standard gamble differ considerably. Standard gamble utilities seem to address different aspects of health status than do rating scale utilities and more traditional outcomes. Utility measurement is sensitive to the method chosen to elicit patient well being.

Adult↗
PubMed1994

Cost effectiveness of group physical therapy compared to individualized therapy for ankylosing spondylitis. A randomized controlled trial.

OBJECTIVE: Cost effectiveness analysis is helpful in setting priorities for funding of health care programs. We studied the cost effectiveness of supervised group physical therapy compared to unsupervised exercises at home in patients with ankylosing spondylitis (AS). METHODS: A total of 144 patients with AS (modified New York criteria; mean age: 43 years) were randomized to unsupervised daily individualized exercises at home for 9 months or the same plus supervised group physical therapy (3 h weekly). At baseline and after 9 months we measured spinal mobility (thoracolumbar flexion and extension), fitness (maximum work capacity by ergometry), and patient's global assessment of change as measured on a visual analog scale. We used a questionnaire at baseline and a diary during the trial to measure AS related direct medical costs, such as doctor visits, paramedical treatment, medication and hospitalization. RESULTS: The mean effects of group therapy and home exercises were, respectively, +0.9 cm (16%) and +0.5 cm (9%) for mobility, +7 watts (4%) and -2 watts (-1%) for fitness, and +1.7 (34%) and +0.3 (6%) for global health. These 3 differences were significant (p < 0.01 for mobility, p = 0.05 for fitness and p < 0.01 for global health). During the trial total medical costs decreased by an average of US $379 (44%) for group therapy, and by $257 (35%)/patient/year for the "home" group. Additional costs of group therapy were estimated at $531/patient/year ($177 for accommodation, $256 for therapist and $98 for materials). After the study 75% of the patients wanted to continue group physical therapy and were willing to pay for it. CONCLUSION: Compared to therapy at home, additional benefits of group therapy cost $531/year, but reduced direct medical costs by $122/year. Hence, the beneficial effects of group therapy cost $409/patient with AS/year.

Adult↗
PubMed1994

Feasibility of utility assessment by rating scale and standard gamble in patients with ankylosing spondylitis or fibromyalgia.

OBJECTIVE: To assess the feasibility of utility measurement in patients with ankylosing spondylitis (AS) or fibromyalgia (FMS). Patient derived utilities provide overall estimates of the impact of a disease on patient well being. METHODS: The Maastricht Utility Measurement Questionnaire was applied cross sectionally to 57 patients with AS and 86 outpatients with FMS. By means of rating scale and standard gamble techniques, patients were asked to value their own health state. RESULTS: All 143 patients completed the interview. Patients with AS valued their personal health state on the rating scale (0-100) considerably higher than patients with FMS (AS: 69 and FMS: 54). Standard gamble utility values (0-1), however, were about the same at a higher level (AS: 0.86 and FMS: 0.83). Four weeks test-retest reliability was examined in 15 patients with FMS. The intraclass correlation coefficient of the utility score for the patient's own health state was 0.56 for the rating scale and 0.66 for the standard gamble technique. CONCLUSION: Feasibility of the Maastricht Utility Measurement Questionnaire was generally satisfactory in both patient groups. Utility values obtained by rating scale and standard gamble technique differed considerably. Our data support the view that utility measurement is sensitive to the method chosen to elicit patient well being.

Activities of Daily Living↗
PubMed1993

Health related utility measurement in rheumatology: an introduction.

Utility measures of health-related quality of life are preference values that patients attach to their overall health status. In clinical trials, utility measures summarize both positive and negative effects of an intervention into one single value between 0 (equal to death) and 1 (equal to perfect health). These measures allow for comparison of patient outcomes of different diseases and allow for comparison between various health care interventions. There are two different approaches to utility measurement. The first is to classify patients into categories based on their responses to a number of questions about their functional status, as for instance the Quality of Well-Being questionnaire. The second approach is to ask patients to assign a single rating to their overall health by means of rating scale, standard gamble, time trade-off, or willingness to pay. The Quality Adjusted Life Year (QALY) as outcome measure includes both effects in terms of quality and quantity of life. Utilities are used as weights to adjust life years for the quality of life in order to calculate QALYs. Both QALYs and utilities are useful in decision-making regarding appropriate procedures for groups of patients.

Health Status↗
PubMed1993

Benefits and costs of recombinant human erythropoietin for end-stage renal failure: a review. Benefits and costs of erythropoietin.

Recombinant human erythropoietin is an efficacious therapy in treatment of the anemia of end-stage renal failure. However, the scale of impact on quality of life and medical care resources remains uncertain. By reviewing the literature we evaluate cost-effectiveness of recombinant human erythropoietin and show how previous studies may have implicitly overestimated cost-effectiveness.

Anemia, Hemolytic↗