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PubMed2004

Endogenous versus exogenous shocks in complex networks: an empirical test using book sale rankings.

We study the precursory and recovery signatures accompanying shocks in complex networks, that we test on a unique database of the Amazon.com ranking of book sales. We find clear distinguishing signatures classifying two types of sales peaks. Exogenous peaks occur abruptly and are followed by a power law relaxation, while endogenous peaks occur after a progressively accelerating power law growth followed by an approximately symmetrical power law relaxation which is slower than for exogenous peaks. These results are rationalized quantitatively by a simple model of epidemic propagation of interactions with long memory within a network of acquaintances. The observed relaxation of sales implies that the sales dynamics is dominated by cascades rather than by the direct effects of news or advertisements, indicating that the social network is close to critical.

Bookselling↗
PubMed2006

Applying Taguchi methods to health care.

PURPOSE: The aim of this article is to show how Taguchi methods can be applied to health care. DESIGN/METHODOLOGY/APPROACH: The quadratic loss function is at the heart of Taguchi methods. It is a powerful motivator for a quality strategy and can be used to adequately model the loss to society in health care. It also establishes a relationship between cost and variability. Therefore, it can be integrated with the performance and parameters of the design of medical applications. Signal-to-noise ratios give a sense of how close is the performance to the ideal. By maximizing the signal-to-noise ratio, quality-engineering activities can be aimed at identifying near-optimum levels of factors and making quality equal to zero. FINDINGS: This article shows that, when the patients' requirements are consistently met, lower losses can provide an impetus to improve patient satisfaction. ORIGINALITY/VALUE: The article outlines areas in health care where Taguchi methods can easily be applied.

Decision Making, Organizational↗
PubMed1985

International migration in Greece: statistical results.

"The aim of this study is to investigate the influence of some socio-economic factors affecting immigration in Greece and the relation of these factors to those affecting internal migration and the migration process as a whole." An econometric model is elaborated using data for 1981. The findings show that standard of living and other socioeconomic factors play an important role in the decision to migrate, particularly in the case of internal migration. (summary in FRE, SPA)

Behavior↗
PubMed1986

International migration and falling into the income 'safety net': social assistance among foreign citizens in Sweden.

The author focuses on public assistance payments to international immigrants in Sweden. "One object of the article is to give a statistical overview of the subject; another is to discuss reasons why international migrants receive social assistance more frequently than others. The latter leads to the formulation of econometric models and the estimation for immigrants with different backgrounds." It is found that "the number of immigrants receiving social assistance has increased since the mid-1960s. We also found that immigrants are considerably more frequent recipients of social assistance than others...." (SUMMARY IN FRE AND SPA)

Demography↗
PubMed2004

The economic burden of smoking in California.

OBJECTIVE: To develop estimates of the direct and indirect costs of smoking for California in 1999. METHODS: A prevalence based approach was used to estimate the annual costs of smoking. Econometric models were used to estimate the smoking attributable fraction (SAF) for direct costs (hospitalisations, ambulatory care, prescription drugs, home health care, and nursing home services) and indirect costs due to lost productivity from smoking related illness. The models controlled for socioeconomic factors and other risk behaviours. Epidemiological methods were used to estimate the SAF for indirect costs due to lost productivity from premature deaths. The SAFs were applied to total health care expenditures, days lost, and deaths to obtain smoking attributable total costs. RESULTS: In 1999, the total costs of smoking in California were 15.9 billion dollars, 475 dollars per resident, and 3331 dollars per smoker. Direct costs were 8.6 billion dollars (54% of the total), indirect costs due to lost productivity from illness were 1.5 billion dollars (10%), and indirect costs due to premature deaths were 5.7 billion dollars (36%). The cost of smoking was 9.4 billion dollars for men and 6.3 billion dollars for women. There were 43,137 deaths attributed to smoking, representing a total of 535,000 years of life lost. The value of life lost per death averaged 132,000 dollars, or 12.4 years. CONCLUSIONS: California smoking related costs are high. The cost methodology presented is useful for other states and nations interested in estimating their costs of smoking. Cost estimates can be used to evaluate the level of cigarette taxes and other policies related to smoking.

Absenteeism↗
PubMed1994

Turning points in international labor migration: a case study of Thailand.

"This article describes the dynamics of the structural transformation of the Thai economy, labor migration and direct foreign investment and proposes an econometric model to explain the migration phenomenon. Though migration shifts have been significantly influenced by political factors such as the Gulf crisis and tensions with Saudi Arabia, economic factors such as the Thai government's liberalization of markets and the expansion of trade and direct foreign investment have contributed to changes in labor market needs. The economic conditions of a shift from net exporter to net importer for labor are posited in the model. The empirical results reveal a turning point in labor migration from Thailand and also confirm the contribution of commodity export in place of labor export in creating employment and income."

Asia↗
PubMed2005

Application of structural equation modeling to health outcomes research.

This article provides an overview of the basic underlying principles of structural equation modeling (SEM). SEM models have two basic elements: a measurement model and a structural model. The measurement model describes the associations between the indicators (observed measures) of the latent variables, whereas the structural model delineates the direct and indirect substantive effects among latent variables and between measured and latent variables. The application of SEM to health outcomes research is illustrated using two examples: (a) assessing the equivalence of the SF-36 and patient evaluations of care for English- and Spanish-language respondents and (b) evaluating a theoretical model of health in myocardial infarction patients. The results of SEM studies can contribute to better understanding of the validity of health outcome measures and of relationships between physiologic, clinical, and health outcome variables.

Cross-Cultural Comparison↗
PubMedDate not supplied

Predicting the cost of illness: a comparison of alternative models applied to stroke.

Predictions of cost over well-defined time horizons are frequently required in the analysis of clinical trials and social experiments, for decision models investigating the cost-effectiveness of interventions, and for macro-level estimates of the resource impact of disease. With rare exceptions, cost predictions used in such applications continue to take the form of deterministic point estimates. However, the growing availability of large administrative and clinical data sets offers new opportunities for a more general approach to disease cost forecasting: the estimation of multivariable cost functions that yield predictions at the individual level, conditional on intervention(s), patient characteristics, and other factors. This raises the fundamental question of how to choose the "best" cost model for a given application. The central purpose of this paper is to demonstrate how to evaluate competing models on the basis of predictive validity. This concept is operationalized according to three alternative criteria: 1) root mean square error (RMSE), for evaluating predicted mean cost; 2) mean absolute error (MAE), for evaluating predicted median cost; and 3) a logarithmic scoring rule (log score), an information-theoretic index for evaluating the entire predictive distribution of cost. To illustrate these concepts, the authors conducted a split-sample analysis of data from a national sample of Medicare-covered patients hospitalized for ischemic stroke in 1991 and followed to the end of 1993. Using test and training samples of about 500,000 observations each, they investigated five models: single-equation linear models, with and without log transform of cost; two-part (mixture) models, with and without log transform, to directly address the problem of zero-cost observations; and a Cox proportional-hazards model stratified by time interval. For deriving the predictive distribution of cost, the log transformed two-part and proportional-hazards models are superior. For deriving the predicted mean or median cost, these two models and the commonly used log-transformed linear model all perform about the same. The untransformed models are dominated in every instance. The approaches to model selection illustrated here can be applied across a wide range of settings.

Cerebrovascular Disorders↗
PubMed2005

Prospective budgeting for home care: making titration work.

OBJECTIVE: To provide a model for prospective budgeting for home care that is plausible, coherent, flexible, and sufficiently tractable that it can serve as a template for practical decision making and to clarify what would be the data requirements and statistical framework to calibrate the model. METHODS: Methods used are standard risk-neutral expected value theory, cost benefit analysis, and the conditional logistic probability model. RESULTS: A simple but effective prospective budgeting model that provides analytic scaffolding for a practical decision support system for home care case managers, consultants, and program evaluators that can improve program equity, efficiency, and effectiveness. DISCUSSION: The author criticizes the well-known Titration Budgeting Model of Weissert, Chernew, and Hirth in terms of its logical and operational problems but then goes on to develop a framework within which the goals of the titration model can be met and home care resources can be more efficiently allocated.

Aged↗
PubMed1993

Development of a claim review and payment model utilizing diagnosis related groups under the Korean health insurance.

This paper describes the development of a claim review and payment model utilizing the diagnosis related groups (DRGs) for the fee for service-based payment system of the Korean health insurance. The present review process, which examines all claims manually on a case-by-case basis, has been considered to be inefficient, costly, and time-consuming. Differences in case mix among hospitals are controlled in the proposed model using the Korean DRGs. They were developed by modifying the US-DRG system. An empirical test of the model indicated that it can enhance the efficiency as well as the credibility and objectivity of the claim review. Furthermore, it is expected that it can contribute effectively to medical cost containments and to optimal practice pattern of hospitals by establishing a useful mechanism in monitoring the performance of hospitals. However, the performance of this model needs to be upgraded by refining the Korean DRGs which play a key role in the model.

Data Collection↗
PubMed1998

The distribution of health care costs and their statistical analysis for economic evaluation.

OBJECTIVE: Where patient level data are available on health care costs, it is natural to use statistical analysis to describe the differences in cost between alternative treatments. Health care costs are, however, commonly considered to be skewed, which could present problems for standard statistical tests. This review examines how authors report the distributional form of health care cost data and how they have analysed their results. METHOD: A review of cost-effectiveness studies that collected patient-level data on health care costs. To supplement the review, five datasets on health care costs are examined. Consideration is given to the use of parametric methods on the transformed scale and to non-parametric methods of analysing skewed cost data. RESULTS: Since economic analysis requires estimation in monetary units, the usefulness of transformation-based methods is limited by the inability to retransform cost differences to the original scale. Non-parametric rank sum methods were also found to be of limited use for economic analysis, partly due to the focus on hypothesis testing rather than estimation. Overall, the non-parametric approach of bootstrapping was found to offer a useful test of the appropriateness of parametric assumptions and an alternative method of estimation where those assumptions were found not to hold. CONCLUSIONS: Guidelines for the analysis of skewed health care cost data are offered.

Cost-Benefit Analysis↗
PubMed2004

Impact of disaster-related mortality on gross domestic product in the WHO African Region.

BACKGROUND: Disaster-related mortality is a growing public health concern in the African Region. These deaths are hypothesized to have a significantly negative effect on per capita gross domestic product (GDP). The objective of this study was to estimate the loss in GDP attributable to natural and technological disaster-related mortality in the WHO African Region. METHODS: The impact of disaster-related mortality on GDP was estimated using double-log econometric model and cross-sectional data on various Member States in the WHO African Region. The analysis was based on 45 of the 46 countries in the Region. The data was obtained from various UNDP and World Bank publications. RESULTS: The coefficients for capital (K), educational enrolment (EN), life expectancy (LE) and exports (X) had a positive sign; while imports (M) and disaster mortality (DS) were found to impact negatively on GDP. The above-mentioned explanatory variables were found to have a statistically significant effect on GDP at 5% level in a t-distribution test. Disaster mortality of a single person was found to reduce GDP by US$0.01828. CONCLUSIONS: We have demonstrated that disaster-related mortality has a significant negative effect on GDP. Thus, as policy-makers strive to increase GDP through capital investment, export promotion and increased educational enrolment, they should always keep in mind that investments made in the strengthening of national capacity to mitigate the effects of national disasters expeditiously and effectively will yield significant economic returns.

Journal Article↗
PubMed1991

Unemployment and highway fatalities.

We considered unemployment, an often overlooked covariate of highway fatalities, hypothesizing that (1) as unemployment rises, aggregate driving decreases, especially among the unemployed, and as driving decreases, fatalities should decrease; (2) unemployment may influence drinking--some among the unemployed may drink less due to lower incomes, while others may drink more due to stress so the net effect would be ambiguous; and (3) unemployment may increase aggregate levels of stress and unhappiness, which can result in poor concentration on driving and thus, in turn, should result in more accidents and deaths. We used data from fifty states and the District of Columbia from 1976-1980, representing 255 observations. (No prior study has as many observations or controls for as many covariates.) Using econometric models of the data, we present evidence for two of the three hypothesized effects of unemployment. We conclude that, if the number of miles driven is held constant, worsening unemployment leads to higher fatality rates, most likely due to stress effects. But because more unemployment means less driving, increases in unemployment, on balance, are associated with decreases in fatalities.

Accidents, Traffic↗
PubMed2006

Pharmacoeconomic analysis of cilostazol for the secondary prevention of cerebral infarction.

BACKGROUND: The antiplatelet agent, cilostazol, is known to reduce the risk of subsequent cerebral infarction. However, the cost effectiveness of such treatment in comparison to aspirin has not been studied. METHODS AND RESULTS: A Markov model was developed to calculate the health outcomes and associated costs for 65-year-old patients with cerebral infarction who were treated with 200 mg/day cilostazol or 81 mg/day aspirin. Cilostazol was more effective, but also more expensive than aspirin. Cilostazol would extend quality-adjusted life years (QALY) by 0.64, while increasing life-time costs by approximately Yen 1.1 million. The incremental cost-effectiveness ratio of cilostazol in comparison with aspirin was estimated to be Yen 1.8 million per QALY. CONCLUSIONS: The use of cilostazol to prevent recurrence of cerebral infarction appears to be cost effective.

Aged↗
PubMed2005

High participation rates are not necessary for cost-effective colorectal cancer screening.

BACKGROUND: In many countries high participation is an explicit target in screening programmes. The desire for high participation often appears to drive screening policy, although it is increasingly recognized that encouraging high participation may impinge upon the rights of an individual to make an informed choice. One argument offered in support of high participation is that it improves the cost-effectiveness of screening. This is questionable on theoretical grounds, and empirically there are conflicting results. Two recent cost-effectiveness models of faecal occult blood test (FOBT) screening for colorectal cancer (CRC) showed that cost-effectiveness was improved, another showed that cost-effectiveness was worsened and a fourth indicated that cost-effectiveness was unaffected by increasing the participation rate. METHODS: We assessed the extent to which different levels and patterns of participation affect cost-effectiveness, using decision modelling of three CRC screening with FOBT scenarios. We estimate the incremental cost-effectiveness (value for money) ratios for each scenario. RESULTS: The way in which participation is modelled, particularly assumptions made about the subsequent screening behaviour of non-participants ("if" and "when" a non-participant attends for subsequent screening), affects the cost-effectiveness estimates for FOBT screening programmes. 100% participation in all screening rounds gives a cost per life year saved (LYS) of USD 9705. Cost-effectiveness is worst when people who do not take part in one screening round (initial or subsequent) never take part in any future rounds of screening. Under this scenario, a participation rate of 20% in second and subsequent rounds gives a cost per LYS of USD 29,500. Under more realistic assumptions, for example the attendance of even a small proportion of non-participants in subsequent rounds, cost-effectiveness is more favourable and similar to that achieved for full participation: the scenario with a random participation rate of 20% in second and subsequent rounds for both participants and non-participants has a cost per LYS of USD 11,270. CONCLUSIONS: Contrary to a commonly held view, high participation in screening programmes is not necessary to achieve cost-effectiveness. Setting high target participation rates in screening programmes does not guarantee cost-effectiveness and may in certain circumstances reduce the cost-effectiveness.

Colorectal Neoplasms↗
PubMedDate not supplied

The value of electronic health records in community health centers: policy implications.

This paper analyzes the costs and benefits of electronic health records (EHRs) in six community health centers (CHCs) that serve disadvantaged patients. EHR-related benefits for most study CHCs did not pay for ongoing EHR costs, yet quality improvement (QI) was substantial. Compared to private practices, CHCs cannot use EHRs to increase visit coding levels and revenues, yet they likely use EHRs more aggressively for QI, which raises equity questions. The evidence suggests that policies are needed that help CHCs to afford EHRs and produce more EHR-related QI gains, including through grants and QI performance rewards.

Ambulatory Care Information Systems↗
PubMedDate not supplied

Analysis of economic impacts of the Hangzhou-Ningbo expressway.

This paper presents an analysis of the effects of the Hangzhou-Ningbo Expressway (in Zhejiang Province of the People's Republic of China) on the region's economic development. An econometric model shows the estimated contributions attributable to the expressway have increased year by year. And statistical data indicate that the Hangzhou-Ningbo Expressway has promoted to some extent the region's economic development in various aspects.

Automobile Driving↗