Biomedical subjects

Mickael Bech

Publications and source records attributed to Mickael Bech.

10 recordsLinked to original sources

PubMed2007

Graded pairs comparison - does strength of preference matter? Analysis of preferences for specialised nurse home visits for pain management.

In the stated preference method called graded pairs comparisons respondents are asked to rate the intensity of their preference for their preferred alternative in a pairwise comparison of alternatives. Econometricians anticipate that the additional information will improve statistical efficiency compared to the standard DCE format. However, this paper reveals that added information inherent in graded pairs scale does not provide smaller standard deviations for the WTP estimated. Secondly, the ordered-response regression models employing the full range of the graded pairs data tend to overestimate WTP, which presumably is caused by the inherent tendency of the ordered-response models to 'predict to the extremes'.

Adult↗

PubMed2006

Ordering effect and price sensitivity in discrete choice experiments: need we worry?

The objective of this paper is to analyse the impact that attribute ordering has on the relative importance of the price attribute. A discrete choice experiment was performed in order to elicit psoriasis patients' preferences for treatment. We tested for ordering effect with respect to the price attribute, and disclosed noticeable higher price sensitivity when the price attribute was placed at the end of the program description. Our results indicate that preferences are context dependent and that heuristics may be used in the choice process. Our result does not, however, suggest that ordering effect is a symptom of lexicographic ordering.

Choice Behavior↗

PubMed2006

Economic evaluation of empirical antisecretory therapy versus Helicobacter pylori test for management of dyspepsia: a randomized trial in primary care.

OBJECTIVES: An economic evaluation was performed of empirical antisecretory therapy versus test for Helicobacter pylori in the management of dyspepsia patients presenting in primary care. METHODS: A randomized trial in 106 general practices in the County of Funen, Denmark, was designed to include prospective collection of clinical outcome measures and resource utilization data. Dyspepsia patients (n = 722) presenting in general practice with more than 2 weeks of epigastric pain or discomfort were managed according to one of three initial management strategies: (i) empirical antisecretory therapy, (ii) testing for Helicobacter pylori, or (iii) empirical antisecretory therapy, followed by Helicobacter pylori testing if symptoms improved. Cost-effectiveness and incremental cost-effectiveness ratios of the strategies were determined. RESULTS: The mean proportion of days without dyspeptic symptoms during the 1-year follow-up was 0.59 in the group treated with empirical antisecretory therapy, 0.57 in the H. pylori test-and-eradicate group, and 0.53 in the combination group. After 1 year, 23 percent, 26 percent, and 22 percent, respectively, were symptom-free. Applying the proportion of days without dyspeptic symptoms, the cost-effectiveness for empirical treatment, H. pylori test and the combination were 12,131 Danish kroner (DKK), 9,576 DKK, and 7,301 DKK, respectively. The incremental cost-effectiveness going from the combination strategy to empirical antisecretory treatment or H. pylori test alone was 54,783 DKK and 39,700 DKK per additional proportion of days without dyspeptic symptoms. CONCLUSIONS: Empirical antisecretory therapy confers a small insignificant benefit but costs more than strategies based on test for H. pylori and is probably not a cost-effective strategy for the management of dyspepsia in primary care.

Adult↗

PubMed2005

The economics of non-attendance and the expected effect of charging a fine on non-attendees.

Non-attendance is claimed to waste substantial health care resources. However, this is only vaguely supported by empirical evidence. The epidemiology of non-attendees is explored in a rather large number of studies along with a sizeable number of studies documenting the effectiveness of various interventions to reduce non-attendance rates. Very few studies include more than one intervention and very few report information on the cost of the intervention which enables only vague conclusions about the cost-effectiveness of the interventions. The effectiveness of charging a fine on non-attendees, which has recently been suggested in Denmark and United Kingdom, has been studied in very few studies. These studies reveal that a fine will as most economists expected reduce the non-attendance rate. The literature of non-attendance discloses an immense need for studies addressing the non-attendance problem applying economic theory and standards of analysis.

Appointments and Schedules↗

PubMed2005

The Danish health care system: evolution--not revolution--in a decentralized system.

The Danish health care system has undergone gradual changes, but not radical reforms, from 1970 until 2004. Theoretically, the development can be viewed from the perspective of fiscal federalism, decentralization, and incentives embodied in reimbursement systems. Furthermore, path dependence and incrementalism have characterized the system. The Danish health care system is decentralized politically, financially, and operationally. The counties are responsible for health care, and finance it out of county income and property taxes along with block grants from the state. Hospitals are publicly owned while general practitioners are private entrepreneurs working on contract with the counties. Hospital services and GP and specialist services are free, while there are co-payments for drugs, adult dental care, physiotherapy and the like. Co-payments make up close to 19% of total health expenditures. The system has been characterized by expenditure control, reasonable positive development in productivity, and a high degree of patient and citizen satisfaction despite waiting lists. Free choice of hospital was introduced more than 10 years ago. It has recently been expanded so that after waiting 2 months for treatments like elective surgery at public hospitals, citizens can choose either private hospitals or go abroad with full payment from public funds. The thinking behind decentralization gradually has been eroded for a number of reasons. This has led to a reform that will be effective as of January 2007. The number of counties will be reduced, but the new regions retain responsibility for health care. A national earmarked health tax will be introduced so that the regions will receive revenues from state block grants and municipal co-payment, for instance an amount per hospitalization.

Denmark↗

PubMed2005

Effects coding in discrete choice experiments.

This paper discusses the inherent problems associated with applying dummy coding when including a fixed comparator in a discrete choice experiment, and seeks to illustrate the misinterpretations that may arise if the analyst is not aware of the problem. This note provides two examples of possible misinterpretations with dummy coding and how it is solved with the use of effects coding.

Choice Behavior↗

PubMed2004

County level responses to the introduction of DRG rates for "extended choice" hospital patients in Denmark.

Choice of hospitals is being discussed in a number of European health systems. The Danish case provides interesting lessons because patients' free choice has been in effect since 1993. This paper explores the responses at the supply side after the introduction of DRG rates for extended choice patients in the Danish hospital system in 2000. The main question is whether the introduction of DRG rates and the resulting changes in incentives have affected county management of health care. How has the county-based governance system, which traditionally has emphasised budget control, co-operation and equity, reacted to the introduction of DRG rates and stronger incentives for "extended choice patients"?

Choice Behavior↗

PubMed2003

Politicians' and hospital managers' trade-offs in the choice of reimbursement scheme: a discrete choice experiment.

Trade-offs in the choice of hospital reimbursement schemes are widely discussed in the health economics literature but no one has previously, to this authors' knowledge, made an attempt at quantifying how purchasers and providers trade-off anticipated outcomes of reimbursement schemes. The purpose of this study is to elicit Danish county council politicians' and hospital managers' preferences for the anticipated incentives and consequences embedded in reimbursement schemes using the discrete choice method. Results indicate that politicians and hospital managers agree that increasing the number of patients treated is the most important objective for the choice of reimbursement scheme. The second most important objective to the politicians is to provide budget safety whereas inducing increased quality of treatment is third. Hospital managers rank inducement of increased quality of treatment as the second most important objective and have the county's budget safety as their third most important objective.

Attitude of Health Personnel↗

PubMed2003

County council politicians' choice of hospital payment scheme: a discrete choice study.

Various hospital payment schemes exist, but none of the schemes fulfil all the objectives of a public payer simultaneously. This implies that trade-offs are involved in the choice of payment scheme. The purpose of this study is to elicit Danish politicians trade-offs in terms of the objectives involved using two elicitation techniques: simple ranking and discrete choice experiments. The implied rankings of the objectives according to the two techniques are compared and reveal discrepancies. The discrepancies may be due to the nature of the techniques and the transparency of the implied ranking to the respondent.

Adult↗

PubMedDate not supplied

Eliciting women's preferences for a training program in breast self-examination: a conjoint ranking experiment.

OBJECTIVES: Although the clinical grounds for recommending breast self-examination (BSE) have been extensively debated in the literature, there has been no investigation into women's preferences for BSE training. The aim of this study was to test the conjoint ranking method using data on women's preferences for different BSE training programs. Different econometric specifications were tested and sample subgroup differences were investigated. METHODS: Postal data were collected from 1258 women with and without previous participation in a BSE training program. The women ranked eight hypothetical training programs that were defined in terms of three attributes. Inclusion of a payment attribute enabled the calculation of marginal willingness-to-pay (WTP) estimates. RESULTS: The marginal WTP for individual training in comparison to group training with 18 to 20 participants was estimated to be 225 Danish Kroner (DKK) to 462 DKK. The marginal WTP for training in groups of eight to 10 participants was 180 DKK to 270 DKK. The respondents also preferred to receive instruction using their own breasts, although this was valued lower than a small group size. The results were similar regardless of whether or not the women had previously participated in BSE training. Around 20% of respondents violated a basic assumption of economic theory, in which the cheaper of two otherwise identical goods should be preferred. CONCLUSIONS: Conjoint ranking can provide comprehensive information about benefit assessment. The approach is cognitively demanding, however, and may cause some respondents to violate the axiom of nonsatiation.

Breast Self-Examination↗