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PubMedDate not supplied

A study on the cost-effectiveness of coronary revascularization: introducing the simultaneous mimic health status model.

An econometric model is presented to compare the cost-effectiveness of two alternative procedures, percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass surgery (CABG), for the treatment of multivessel coronary artery disease. This study utilizes the MIMIC (multiple indicator multiple cause) health model in a simultaneous equation system to analyse Emory Angioplasty Surgery Trial (EAST) data. This method eliminates the possibility of endogeneity bias, which may have affected the results of previous cost-effectiveness analyses on this topic. The empirical results indicate that neither procedure proves more cost-effective at 3 year follow-up.

Angioplasty, Balloon, Coronary↗

PubMed1994

Econometric mixture models and more general models for unobservables in duration analysis.

This paper considers models for unobservables in duration models. It demonstrates how cross-section and time-series variation in regressors facilitates identification of single-spell, competing risks and multiple spell duration models. We also demonstrate the limited value of traditional identification studies by considering a case in which a model is identified in the conventional sense but cannot be consistently estimated.

Algorithms↗

PubMed2005

Predictive modeling of total healthcare costs using pharmacy claims data: a comparison of alternative econometric cost modeling techniques.

OBJECTIVE: We sought to evaluate several statistical modeling approaches in predicting prospective total annual health costs (medical plus pharmacy) of health plan participants using Pharmacy Health Dimensions (PHD), a pharmacy claims-based risk index. METHODS: We undertook a 2-year (baseline year/follow-up year) longitudinal analysis of integrated medical and pharmacy claims. Included were plan participants younger than 65 years of age with continuous medical and pharmacy coverage (n = 344,832). PHD drug categories, age, gender, and pharmacy costs were derived across the baseline year. Annual total health costs were calculated for each plan participant in follow-up year. Models examined included ordinary least squares (OLS) regression, log-transformed OLS regression with smearing estimator, and 3 two-part models using OLS regression, log-OLS regression with smearing estimator, and generalized linear modeling (GLM), respectively. A 10% random sample was withheld for model validation, which was assessed via adjusted r, mean absolute prediction error, specificity, and positive predictive value. RESULTS: Most PHD drug categories were significant independent predictors of total costs. Among models tested, the OLS model had the lowest mean absolute prediction error and highest adjusted r. The log-OLS and 2-part log-OLS models did not predict costs accurately as the result of issues of log-scale heteroscedasticity. The 2-part model using GLM had lower adjusted r but similar performance in other assessment measures compared with the OLS or 2-part OLS models. CONCLUSION: The PHD system derived solely from pharmacy claims data can be used to predict future total health costs. Using PHD with a simple OLS model may provide similar predictive accuracy in comparison to more advanced econometric models.

Adolescent↗

PubMed1980

A national econometric forecasting model of the dental sector.

The Econometric Model of the the Dental Sector forecasts a broad range of dental sector variables, including dental care prices; the amount of care produced and consumed; employment of hygienists, dental assistants, and clericals; hours worked by dentists; dental incomes; and number of dentists. These forecasts are based upon values specified by the user for the various factors which help determine the supply an demand for dental care, such as the size of the population, per capita income, the proportion of the population covered by private dental insurance, the cost of hiring clericals and dental assistants, and relevant government policies. In a test of its reliability, the model forecast dental sector behavior quite accurately for the period 1971 through 1977.

Dental Health Services↗

PubMed2006

Evaluating the effectiveness of the Massachusetts workforce development system using no-shows as a nonexperimental comparison group.

This article examines the effect of the Massachusetts workforce development system on the earnings of disadvantaged adults using nonexperimental data from the late 1990s. The authors construct a comparison sample for program participants using individuals who apply for and are offered services yet do not participate in a training program. They present a series of difference-in-difference estimates that make several alternative efforts to correct for selectivity bias, including econometric models that regression adjust for observable characteristics and fixed-effect models that adjust for time-invariant person effects. They also employ probabilistic matching techniques to more finely align the treatment and comparison samples. On average, program participants experienced 20% increases in annual earnings 1 year postintervention and 25% increases after 2 years. The authors uncover considerable heterogeneity in these effects, suggesting that the most difficult to serve and the most job ready benefit the least.

Education↗

PubMed1996

Registered nurse turnover and the changing health care system.

Changes in health care delivery and cyclic fluctuations in the registered nurse (RN) labor market affect health care costs, access, and quality. This study provides insight into one factor central to these issues, the job-change behavior of RNs. The theory of human capital provides the foundation to guide investigation, and econometric modeling is used to explore relationships among study variables. Model results show clear differences in job change behavior of nurses employed in hospital and nonhospital settings. These differences are a reflection, not only of individual nurse preferences, but also of wages, working conditions, and opportunities associated with various health care settings. Understanding these relationships is essential to leaders in the nursing profession as they plan for and respond to changes in health care delivery.

Adult↗

PubMed1999

Duplicate coverage and demand for health care. The case of Catalonia.

An individual has duplicate coverage when he enjoys a compulsory medical public insurance, and in addition he has purchased a private one. This paper studies the implications of duplicate coverage on both demand for visits to specialists and on the selection process of the private insurance market. Econometric models, estimated by the generalized method of moments, accommodate both the endogeneity of insurance choice decision and the non-negativity of the variable number of visits. The choice of instrumental variables is motivated within a theoretical model of demand for health care. The results shows that endogeneity is important for the subsample of heads of household, but not for the subsample of non-heads of household. For the subsample of non-heads of household, a positive effect of duplicate coverage on the number of visits to specialists is found. Health related variables, education and income are also important. Results are consistent with the idea that heads of household that buy private insurance are the ones with poor unobservable health conditions. It is argued that this last result is related to the existence of a compulsory public insurance.

Health Services Needs and Demand↗

PubMed2006

Why worry about awareness in choice problems? Econometric analysis of screening for cervical cancer.

The decision to undertake a screening test is conditional upon awareness of screening. From an econometric perspective there is a potential selection problem, if no distinction is made between aware and unaware non-screeners. This paper explores this problem through analysis of the determinants of cervical screening in Australia. Cervical cancer is one of the most preventable and curable forms of cancer. Since 1991 there has been a concerted effort in Australia to recommend and encourage women to have Pap smears every two years. The success of this program can be partly gauged by exploring the determinants of screening for cervical cancer. Using unit record data from the 1995 National Health Survey, an econometric model is developed for whether women have ever screened or not. A proportion of women in the sample contend that they have never heard of a Pap test. The analysis characterizes this group of women and accounts for their presence in the modelling. The paper demonstrates failing to model awareness can result in inconsistent parameter estimates even when the degree of censoring in the sample is relatively small.

Adolescent↗

PubMed2006

Economic evaluation of health effects with preference imprecision.

The estimation of economic benefits of health effects through direct methods, such as contingent valuation, presents the problem of preference imprecision. This paper deals with this problem by proposing an elicitation method that allows the subject to state an interval for willingness to pay, without inducing any specific amount as a response. The paper also analyzes the effects of the context where changes in health occur on the associated imprecision level and the estimates, by comparing a situation without context with another in which effects are due to atmospheric pollution. The econometric modelling develops a Bayesian estimation method for censored intervals, which models the existing uncertainty between the lower and upper limits derived from the elicitation process. Results prove that data dispersion is significantly higher for the non-contextual scenario, and increases for the most severe symptoms.

Bayes Theorem↗

PubMed2006

The effect of managed care on use of health care services: results from two contemporaneous household surveys.

This paper estimates treatment effects of managed care plans on the utilization of health care services using data from two contemporaneous, nationally representative household surveys from the USA. The paper exploits recent advances in simulation-based econometrics to take the endogeneity of enrollment into managed care plans into account and identify the causal relationship between managed care enrollment and utilization. Overall, results from the two surveys are remarkably similar, lending credibility to their external validity and to the econometric model and estimation methods. There is significant evidence of self-selection into managed care plans. After accounting for selection, an individual enrolled in an health maintenance organization (HMO) plan has 2 more visits to a doctor and has 0.1 more visits to the emergency room per year than would the same individual enrolled in a nonmanaged care plan.

Adolescent↗

PubMed2007

Progressive segmented health insurance: Colombian health reform and access to health services.

Equal access for poor populations to health services is a comprehensive objective for any health reform. The Colombian health reform addressed this issue through a segmented progressive social health insurance approach. The strategy was to assure universal coverage expanding the population covered through payroll linked insurance, and implementing a subsidized insurance program for the poorest populations, those not affiliated through formal employment. A prospective study was performed to follow-up health service utilization and out-of-pocket expenses using a cohort design. It was representative of four Colombian cities (Cendex Health Services Use and Expenditure Study, 2001). A four part econometric model was applied. The model related medical service utilization and medication with different socioeconomic, geographic, and risk associated variables. Results showed that subsidized health insurance improves health service utilization and reduces the financial burden for the poorest, as compared to those non-insured. Other social health insurance schemes preserved high utilization with variable out-of-pocket expenditures. Family and age conditions have significant effect on medical service utilization. Geographic variables play a significant role in hospital inpatient service utilization. Both, geographic and income variables also have significant impact on out-of-pocket expenses. Projected utilization rates and a simulation favor a dual policy for two-stage income segmented insurance to progress towards the universal insurance goal.

Colombia↗

PubMedDate not supplied

Should you eat breakfast? Estimates from health production functions.

This paper uses an econometric specification based on the health production function approach to examine the importance of lifestyles for adult health. The approach treats health practices such as eating breakfast, smoking, and exercise as inputs into the production of good health; several output measures are explored. The econometric models estimated with data from the 1985 Health Interview Survey show broad agreement with conventional wisdom about the importance of healthy lifestyles. This paper also investigates the role schooling plays in the production of good health. Schooling is found to be related to good health even after controlling for differences in observable health inputs. However, lack of support for a plausible specification of the productive efficiency hypothesis casts some doubt on the interpretation that schooling increases the efficiency of the household production of health.

Age Factors↗

PubMedDate not supplied

Infant mortality time series are random walks with drift: are they cointegrated with socioeconomic variables?

Previous time series analyses of infant mortality have failed to provide evidence to support their implicit assumption that infant mortality data used behaved as a stationary time series. The present study applies the augmented Dickey Fuller Test to infant mortality time series for Sweden (1800-1989), United Kingdom (1839-1989) and United States (1915-1989). The null hypothesis that each of these series is non-stationary is accepted at standard levels of significance. A conceptual framework of infant mortality which uses a combination of physical and social overhead capital as factors in a production function is developed to explain the finding of non-stationarity as derivative from the non-stationarity of a stock of health-enhancing capital. Estimation of econometric models of the socioeconomic determinants of infant mortality using differenced data with ARIMA estimation is inconclusive. Estimation of a bivariate cointegration model supports the hypothesis that infant survival and GNP/Capita are cointegrated for 19th century Sweden but not for 19th century UK. Bivariate analysis of 20th century Sweden, UK, and US data demonstrated no cointegration. This may be due to the onset of disequilibrium in the economic determination of infant mortality in the present era as technological advances and demographic shifts began to play a larger role. Supplementing the bivariate analysis with measures of unemployment, and crude birth rate in the 20th century permitted the detection of cointegration in US and UK. The multivariate results may suggest that improvements in 20th century UK GNP/capita have had greater impact on infant survival relative to US GNP/capita.

Birth Rate↗

PubMedDate not supplied

Investigating hospital efficiency in the new NHS: the role of the translog cost function.

The reforms to the United Kingdom's National Health Service (NHS) of recent years have greatly increased the role of economic incentives in the hospital sector. Hospitals now have to compete for the business of GP and health authority purchasers and are assumed to have an incentive to minimise costs. This makes the analysis of cost functions much more relevant than has previously been the case. The objective of this paper is to assess the potential usefulness of the translog cost function applied in the NHS internal market. Three main issues are identified that limit the role of this type of cost function in the internal market: the adequacy of the econometric model (including data quality); the assumptions underlying the model, and; the interpretation of economies of scale, marginal costs and economies of scope that can be derived from such a cost function. It is concluded that at present the application of translog cost function analysis in the NHS is of limited usefulness, but that it does indicate areas for further methodological research.

Economic Competition↗

PubMed2002

Medicaid matters: children's health and Medicaid eligibility expansions.

In the late 1980s, a series of federal laws were enacted which expanded Medicaid eligibility to more of the nation's children. States had a great amount of discretion in how fast and how far these expansions were implemented. As a result, there was great variation among the states in defining who was eligible for the program. This variation provides a rare opportunity to disentangle the effect of Medicaid from a child's socioeconomic status. Using data from the National Health Interview Survey, we address whether the Medicaid expansions improved the health and functional status of children. Econometric models were developed using fixed-effects regressions, and were estimated separately for white, black, and Hispanic children. White children experienced statistically significant reductions in acute health conditions and functional limitations. Black and Hispanic children showed some evidence of improved health conditions and functional status, but this evidence is inconclusive in the study sample. This may be due to differences in their access to appropriate health services or to the smaller sample size of minorities in each geographic area. The findings are also relevant to the implementation of the Children' Health Insurance Program (CHIP), the latest federal effort to expand access to health care to poor and near poor children. In many states, CHIP is being implemented in whole or in part through further Medicaid expansions.

Black or African American↗

PubMed1992

The validity of the MIMIC (Multiple Indicators/MultIple Causes) health index--some empirical evidence.

This study evaluates the potential of econometric models with latent (unobservable) variables for measuring health or health impairment due to a specific disease. A MIMIC disability index is estimated for a sample of 145 adults with chronic bronchitis, expressing their self-reported disability caused by the disease on a one-dimensional scale. The index is determined up to a linear transformation. Disability is thus measured on an interval scale. The data were collected by interviews. The questionnaire used for this purpose is based on a number of in-depth interviews with selected bronchitis patients conducted beforehand. The study therefore focuses directly on the patients' perceptions of their disease. The validity of the index is evaluated in three different ways. First, construct validity is assessed performing groupwise analysis and testing for differences in the index values by subgroup. To a large extent, the index is consistent with a priori expectations. Therefore, we conclude that it has high construct validity. Second, validity of the index is assessed by comparing its results to a direct rating scale produced by 21 physicians with various medical backgrounds. The MIMIC index turns out to be related in a systematic, but nonlinear way to this direct rating scale. This can be interpreted in two different ways. If one accepts the preferences of health providers as the ultimate yardstick when it comes to ranking health or chronic states the result suggests that the MIMIC index estimated in this way is not a valid measure of treatment success. By contrast, if patients' preferences are considered to be decisive, it suggests that physician-based ratings should be substituted for or at least complemented with patient-based indices (such as the MIMIC disability index estimated here) when evaluating medical services in terms of cost-effectiveness. Third we explore the extent to which the MIMIC index reflects utility associated with different states of disability, using a modified Torrance Standard Gamble approach. The above-mentioned physicians are used as experts in this procedure. The results indicate that the MIMIC index as estimated here is related in a systematic, but nonlinear way to the Standard Gamble risk index as well. The fact that this relationship is nonlinear indicates that the MIMIC index does not measure utility as derived from the experts' preferences directly. How this index would fare compared to a Standard Gamble risk index provided by patients (bronchitis subjects) is a question which remains open.(ABSTRACT TRUNCATED AT 400 WORDS)

Attitude to Health↗

PubMed2006

Determinants of household health expenditure on western institutional health care.

We try to identify determinants of illness reporting, provider choice and resulting expenditure with different econometric models using data from a representative household panel survey of 800 households in Nouna health district, Burkina Faso, during 2000-2001. The factors "being an adult", "married", "illness occurred in rainy season" and "severe illness" significantly increased the magnitude of health expenditure. Compared to malaria, individuals spent more on other infectious diseases, injury and the other disease category. In contrast, people were less likely to spend on chronic illness. An individual who belonged to a household headed by a female, a literate household head and with a higher household expenditure had a significantly positive association with the magnitude of expenditure. Findings from this study can be used for policy implication to improve health system performance in Burkina Faso through enhancing health care utilization.

Adult↗

PubMed2005

Analysis and implications of the determinants of healthcare expenditure in African countries.

The income elasticity of health care spending in the OECD countries tends toward luxury good values. Similar studies, based on more recent data, and capable of informing macroeconomic health policies of the African countries, do not currently exist. How the health care expenditure in Africa responds to changes in the Gross Domestic Products (GDP), Official Development Assistance (ODA), and other determinants, is also relevant for health policy because health care is a necessity in the 'basic needs' theory of economic development. This paper presents econometric model findings of the determinants of per-capita health expenditure (in PPPs) for 26 African countries, using the flexible Box-Cox model regression methods and 1995 cross-sectional data (sources: WRI, UNEP, UNDP, The World Bank). The economic and other determinants, capturing 74 percent of the variations in health expenditures, include per-capita GDP (in PPPs), ODA (US dollar), Gini income inequality index, population dependency ratio, internal conflicts, and the percentage of births attended by trained medical workers. Income inequality dampens, while the ODA and population per health personnel raise health care expenditure. The GDP elasticity of about 0.6 signals the tendency for health care to behave like a technical 'necessity'. Implications for sustainable basic health development policies are discussed.

Africa↗