PubMed Health⌕ Search

Biomedical subjects

P Zweifel

Publications and source records attributed to P Zweifel.

At least 19 recordsLinked to original sources
PubMed2005

[Cost comparison of two combination therapies with peginterferon alfa and ribavarin for the treatment of hepatitis C].

The two approved combination therapies for the treatment of hepatitis C in Switzerland (Pegasys/Copegus, PAC; PegIntron/Rebetol, PIR) are very similar in terms of efficacy and safety. This study aims at comparing the cost of the two therapies and determining the cost-efficient treatment algorithm. Average cost amounts to CHF 21700.-(PAC) and CHF 19700.- (PIR) for patients with genotype 1 and to CHF 15600.- (PAC) and CHF 15000.- (PIR) for patients with genotype 2/3, respectively. The consistent use of PIR is 9 to 12% cheaper than PAC. Further cost savings of 3% are possible if patients with a bodyweight below 85 kg (genotype 1) or below 75 kg (genotype 2/3) are treated with PIR while patients with a bodyweight over 85 kg (genotype 1) or over 75 kg (genotype 2/3) are treated with PAC.

Algorithms↗
PubMed2001

Reply to: Econometric issues in testing the age neutrality of health care expenditure.

Salas and Raftery allege that in our paper, (1) remaining life expectancy is an endogenous explanatory variable of health care expenditure and (2) the parameter designed to correct for sample selection bias in fact represents a hidden relationship between health care expenditure and age. We argue that claim (1) is not supported by the available empirical evidence, while claim (2) seems to derive from a too cursory reading of our paper.

Age Factors↗
PubMed2000

Switzerland.

Explore the source record for details and available documents.

Economic Competition↗
PubMed2000

Criteria for the future division of labor between private and social health insurance.

This article's point of departure is that the individual has to manage three stochastic assets, namely health, wealth, and wisdom (skills), which tend to be positively correlated. It shows that the unexpected components of insurance payments should be negatively correlated for minimizing total asset volatility. The empirical finding is that in the United States, Japan, and Germany, the lines of social insurance contribute less to diversification than do those of private insurance. The article concludes with suggestions for new, umbrella-type insurance contracts that in the future should help individuals in the efficient management of their assets.

Germany↗
PubMed1999

Ageing of population and health care expenditure: a red herring?

This paper studies the relationship between health care expenditure (HCE) and age, using longitudinal rather than cross-sectional data. The econometric analysis of HCE in the last eight quarters of life of individuals who died during the period 1983-1992 indicates that HCE depends on remaining lifetime but not on calendar age, at least beyond 65+. The positive relationship between age and HCE observed in cross-sectional data may be caused by the simple fact that at age 80, for example, there are many more individuals living in their last 2 years than at age 65. The limited impact of age on HCE suggests that population ageing may contribute much less to future growth of the health care sector than claimed by most observers.

Aged↗
PubMed1998

Cream-skimming in deregulated social health insurance: evidence from Switzerland.

Policymakers fear that health insurers when exposed to competition will engage in cream-skimming (i.e. selection of good risks) rather than trying to improve their benefit to premium ratio. This fear surfaced also when Swiss federal government proposed pro-competitive Law on social health insurance, which barely passed a popular referendum in 1994. While a risk equalization mechanism based on age, gender, and place of residence has already been created, there is a considerable interest in improving its formula. This paper shows that a dummy variable indicating an individual's death during the period of observation causes the coefficient of determination to jump from 0.039 to 0.111. More-over, simulations of the risk selection process suggest that risk equalization should be made a permanent institution rather than being limited to a life of 10 years as prescribed by present legislation. In fact, the formula in use, with all its shortcomings, can be shown to neutralize to a great extent insurer interest in cream skimming provided he takes a longer-run view.

Actuarial Analysis↗
PubMed1998

Modeling cross-border care in the EU using a principal-agent framework.

Cross-border care is likely to become a major issue among EU countries because patients have the option of obtaining treatment abroad under Community Regulations 1408/71. This paper develops a model formalizing both the patient's decision to apply for cross-border care and the authorizing physician's decision to admit a patient to the program. The patient is assumed to maximize expected utility, which depends on the quality of care and the length of waiting in the home country and the host country, respectively. Not all patients qualifying for the EU program present themselves to the authorizing physician because of the transaction cost involved. The physician in her turn shapes effective demand for authorization through her rate of refusal, which constitutes information to potential applicants about the probability of obtaining treatment abroad. The authorizing physician thus acts as an agent serving two principals, her patient and her national government, trading off the perceived utility loss of patients who are rejected against her commitment to domestic health policy. The model may be used to explain existing patient flows between EU countries.

Catchment Area, Health↗
PubMed1998

The demand for health: an empirical test of the Grossman model using panel data.

Grossman derives the demand for health from an optimal control model in which health capital is both a consumption and an investment good. In his approach, the individual chooses his level of health and therefore his life span. Initially an individual is endowed with a certain amount of health capital, which depreciates over time but can be replenished by investments like medical care, diet, exercise, etc. Therefore, the level of health is not treated as exogenous but depends on the amount of resources the individual allocates to the production of health. The production of health capital also depends on variables which modify the efficiency of the production process, therefore changing the shadow price of health capital. For example, more highly educated people are expected to be more efficient producers of health who thus face a lower price of health capital, an effect that should increase their quantity of health demanded. While the Grossman model provides a suitable theoretical framework for explaining the demand for health and the demand for medical services, it has not been too successful empirically. However, empirical tests up to this date have been exclusively based on cross section data, thus failing to take the dynamic nature of the Grossman model into account. By way of contrast, the present paper contains individual time series information not only on the utilization of medical services but also on income, wealth, work, and life style. The data come from two surveys carried out in 1981 and 1993 among members of a Swiss sick fund, with the linkage between the two waves provided by insurance records. In all, this comparatively rich data set holds the promise of permitting the Grossman model to be adequately tested for the first time.

Depreciation↗
PubMed1998

Managed care in Germany and Switzerland. Two approaches to a common problem.

The point of departure for this contribution is a problem common to all Western healthcare systems, namely the deficiency of their basic building block, the physician-patient relationship. This deficiency opens up a market for complementary agents in healthcare, ranging from medical associations to the central government. While Germany has traditionally put the emphasis on medical associations as the dominant complementary agent (DCA), it is shifting towards the central government. Switzerland, on the other hand, traditionally has relied on the cantonal governments and is now moving towards competing (quasi-) private health insurers that would function as DCAs. Thus, managed care, which is a means through which to reshape the physician-patient relationship, is used quite differently in the 2 countries, with differing expected outcomes and different consequences for the pharmaceutical industry.

Delivery of Health Care↗
PubMed1994

Agency relationships in psychotherapy: an economic analysis.

This paper takes the economist's point of view for explaining why psychotherapy seems to be a particularly difficult discipline and what could be done about it. Whereas the so-called agency relationship (i.e. a specialized agent acting on behalf of an uninformed client) can be counted upon to resolve some of the problems in somatic care, it risks to fail in psychic care because the client frequently expresses inconsistent preferences. For this reason, family members and general practitioners may serve as comparatively good agents in ambulatory care, while in the inpatient segment of psychotherapy, patient-oriented objectives tend to be thwarted. An important condition for agency relationships to perform well, however, is that the client carry a sufficient 'price tag', implying that his treatment contributes to the economic objectives of the agent in charge. The conclusion is that choice of agency relationships, even if resulting in seemingly wasteful parallel treatment, gives rise to competition between agents for patients and thus may serve as one of the best safeguards of patients' interests in psychotherapy.

Ambulatory Care↗
PubMed1987

Bonus systems in health insurance: a microeconomic analysis.

Faced with the cost explosion in the health care sector, policy-makers in most industrialized countries have been focusing on cost-sharing in health insurance as a possible solution. This is a sanction meted out to users of medical care; the alternative of creating positive incentives for non-users has not yet received nearly as much attention. This paper reports on the experiences made by German private health insurers with their plans offering rebates as well as experience-rated bonuses for no claims. It is argued that a rebate offer may be at least as attractive as conventional cost-sharing plans from the point of view of the consumer since these new options allow him to choose the time at which he is to bear the financial consequences of an illness. In the second part of the paper, predictions are derived concerning the incentives contained in the policies written by three particular insurers. Clear evidence of a decrease in demand for ambulatory medical care at the lower end of the billings distribution is found in rebate and bonus plans. The concluding section of the paper contains a discussion of the results with a view on the continuing debate about the reform of social health insurance.

Community Participation↗