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PubMed1983

Price and income elasticities of demand for alcoholic beverages.

Estimating the demand for alcoholic beverages represents a difficult statistical problem. A number of studies have attempted to estimate the demand for beer, wine, distilled spirits, or total alcohol consumption. The results vary widely according to country of study, data used, and model and statistical technique. For the United States, most studies find the demand for beer to be relatively price inelastic, at around -0.3. The demand for distilled spirits appears to be unitary price elasticity or somewhat greater, around -1.5. The evidence on wine is too sketchy to draw any conclusions. There is no strong evidence of substitutability among beer, wine, and distilled spirits based on econometric models, nor evidence that advertising plays a strong role in the aggregate demand for beer, wine, or distilled spirits. The main policy implication is that price increases to control consumption will have a stronger impact on the consumption of distilled spirits than on beer.

Alcohol Drinking↗
PubMed2006

The market for elective surgery: joint estimation of supply and demand.

This paper develops models of the demand for and supply of elective (non-emergency) surgery using a panel of quarterly data for 200 English hospitals over the period 1995-2002. Unusually, distinct measures of supply (outpatients seen and inpatient admissions) and demand (outpatient referrals and decisions to admit) are available for each observation. These offer the opportunity to estimate separate empirical models of supply and demand using ordinary least squares (OLS) regression methods. However, the strong correlation between the residuals of these models suggests some merit in the deployment of seemingly unrelated regression (SUR) methods. Although both static and dynamic SUR estimations leave the results largely qualitatively unchanged, SUR estimation can have a considerable quantitative effect relative to the OLS results. For example, SUR estimation generates a lower elasticity of inpatient demand with respect to waiting time than that obtained via OLS. The results offer an important justification for more careful econometric modelling of hospital behaviour than has traditionally been employed in the health economics literature.

Elective Surgical Procedures↗
PubMedDate not supplied

Global budgets and excess demand for hospital care.

Excess demand is a pervasive feature of health care systems that use global budgets to pay for hospital care, regardless of the amount of money spent by those systems. This paper presents a theory that explains this feature of global budgets. The theory emphasizes that hospital administrators control the allocation of their budget, and that they choose quantity and resource intensity to maximize their own utility. The equilibrium quantity of care provided may be less than quantity demanded by consumers, leading to excess demand for admissions. An increase in the hospital's budget may even be associated with an increase in excess demand.

Budgets↗
PubMedDate not supplied

Equity in health care utilization: further tests based on hurdle models and Swedish micro data.

This paper tests the null hypothesis of no horizontal inequity in delivery of health care by use of count data hurdle models and Swedish micro data. It differs from most earlier work in three principal ways: First, the tests are carried out separately for physician and hospital care; second, the tests are carried out separately for the probability of seeking care and the amount of care received (given any use); and third, the tests are based on a model that includes several socioeconomic variables, e.g. income, education and size of community of residence. The paper rejects the hypothesis of no inequity because socioeconomic factors also have significant effects on utilization, e.g. income and size of community of residence. Size of community of residence has a positive significant effect on the frequency of physician visits but not on the probability of visiting a physician.

Adolescent↗
PubMed1999

The economic consequences of reorganizing hospital services in Bishkek, Kyrgyzstan.

Kyrgyzstan gained independence from the Soviet Union in 1991 and has since been thrown into severe financial crisis. All public sector funding has been significantly reduced and international aid agencies are supporting the government in rebuilding the economy. The health sector requires a radical overhaul and a major part of this process involves rationalization of existing facilities, particularly in the capital Bishkek, where 26 secondary and tertiary hospitals support a population of approximately 800000 people. This paper describes the development of a plan for rationalization with particular emphasis on the economic aspects of the process. This involved calculating future hospital requirements by modelling a variety of policy options, ranging from changes to clinical practice to hospital closures. The model generates estimates of resource requirements at each hospital, from which the costs falling on the health budget and patients are derived.

Adult↗
PubMed1999

Modelling the EuroQol data: a comparison of discrete choice conjoint and conditional preference modelling.

This article compares two measurement strategies for measuring EuroQol health state preferences: (a) conditional preference modelling, implemented using rating scale and standard gamble scaling methods and (b) discrete choice conjoint modelling. The nature of the model form of the EuroQol health status preference function and the predictive ability of each measurement strategy formed the basis of the comparison. Data were collected via personal interviews with 140 US patients, 139 of whom provided usable responses. Both strategies supported a multiplicative model form as representative of the EuroQol health status preference function and were acceptable in terms of predictive ability. The agreement of the two measurement strategies on the nature of the model form provides evidence of the convergent validity of the multiplicative nature of the EuroQol health status preference function in this patient population. Since both strategies were found to be acceptable in terms of predictive ability, further research comparing preference scores and measuring respondent evaluations of the methodologies is necessary to illustrate the relative strengths and weaknesses of different health state preference measurement methodologies.

Aged↗
PubMed2000

Interpreting the rational addiction model.

The rational addiction (RA) model of Becker and Murphy (Becker GS, Murphy KM. A theory of rational addiction. J Pol Econ 1988; 96(4): 675-700) has rapidly become one of the standard models in the literature on addictive behaviour. This paper reviews some theoretical issues surrounding its use, and indicates areas in which caution should be used in applying this model.

Behavior, Addictive↗
PubMed2007

Multilevel models for estimating incremental net benefits in multinational studies.

Multilevel models (MLMs) have been recommended for estimating incremental net benefits (INBs) in multicentre cost-effectiveness analysis (CEA). However, these models have assumed that the INBs are exchangeable and that there is a common variance across all centres. This paper examines the plausibility of these assumptions by comparing various MLMs for estimating the mean INB in a multinational CEA. The results showed that the MLMs that assumed the INBs were exchangeable and had a common variance led to incorrect inferences. The MLMs that included covariates to allow for systematic differences across the centres, and estimated different variances in each centre, made more plausible assumptions, fitted the data better and led to more appropriate inferences. We conclude that the validity of assumptions underlying MLMs used in CEA need to be critically evaluated before reliable conclusions can be drawn.

Cost-Benefit Analysis↗
PubMed2004

Alcohol and marijuana use among college students: economic complements or substitutes?

Previous research has shown that the recent tightening of college alcohol policies has been effective at reducing college students' drinking. Over the period in which these stricter alcohol policies have been put in place, marijuana use among college students has increased. This raises the question of whether current policies aimed at reducing alcohol consumption are inadvertently encouraging marijuana use. This paper begins to address this question by investigating the relationship between the demands for alcohol and marijuana for college students using data from the 1993, 1997 and 1999 waves of the Harvard School of Public Health's College Alcohol Study (CAS). We find that alcohol and marijuana are economic complements and that policies that increase the full price of alcohol decrease participation in marijuana use.

Adult↗
PubMed2004

Health insurance and treatment seeking behaviour: evidence from a low-income country.

This paper analyses the effect of being insured under the voluntary component of Vietnamese Health Insurance, on patterns of treatment seeking behaviour. A multinomial logit model is estimated using household survey data from three provinces in Vietnam. Decisions regarding both the type of provider sought and type of care received are analysed. Insurance status is treated as both exogenous and endogenous to account for potential selection bias. The results indicate that, overall, insured patients are more likely to use outpatient facilities, and public providers, an effect that is particularly strong at lower income levels.

Adult↗
PubMed2004

Deriving welfare measures in discrete choice experiments: a comment to Lancsar and Savage (1).

Lancsar and Savage argue that current methods of deriving welfare estimates, using discrete choice experiments, are inconsistent with random utility and welfare theory. In this paper I show that this not the case. The general formula proposed by Small and Rosen for estimating welfare, which Lancsar and Savage claim should be used, reduces to the method used by health economists for state of the world models. The important question then becomes when are state of the world models, as opposed to multiple alternative models, appropriate?

Asthma↗
PubMed2004

Deriving welfare measures from discrete choice experiments: inconsistency between current methods and random utility and welfare theory.

Discrete choice experiments (DCEs) are being used increasingly in health economics to elicit preferences for products and programs. The results of such experiments have been used to calculate measures of welfare or more specifically, respondents' 'willingness to pay' (WTP) for products and programs and their 'marginal willingness to pay' (MWTP) for the attributes that make up such products and programs. In this note we show that the methods currently used to derive measures of welfare from DCEs in the health economics literature are not consistent with random utility theory (RUT), or with microeconomic welfare theory more generally. The inconsistency with welfare theory is an important limitation on the use of such WTP estimates in cost-benefit analyses. We describe an alternative method of deriving measures of welfare (compensating variation) from DCEs that is consistent with RUT and is derived using welfare theory. We demonstrate its use in an empirical application to derive the WTP for asthma medication and compare it to the results elicited from the method currently used in the health economics literature.

Activities of Daily Living↗
PubMed2005

On a policy of transferring public patients to private practice.

We consider an economy where public hospitals are capacity-constrained, and we analyse the willingness of health authorities to reach agreements with private hospitals to have some of their patients treated there. When physicians are dual suppliers, we show that a problem of cream-skimming arises and reduces the incentives of the health authority to undertake such a policy. We argue that the more dispersed are the severities of the patients, the greater the reduction in the incentives will be. We also show that, despite the patient selection problem, when the policy is implemented it is often the case that health authorities decide a more intensive transfer of patients to private practice.

Benchmarking↗
PubMedDate not supplied

Medical technology and health expenditure: an economic review and a proposal.

This paper is an evaluative survey of the economic literature on the relationship between technology and/or innovation and health expenditures. Various types of analysis viz. econometric modelling; three residual approaches; the cost-of-illness approach; and the literature on supplier interests are contrasted, and the results presented. The paper concludes with a discussion of the policy and planning implications, and a simple, and conventional, proposal is made that could unambiguously determine this relationship in the case of process innovations.

Diffusion of Innovation↗
PubMed2002

Investigating public decisions about protecting wetlands.

Quantitative analyses of species protection decisions taken by public authorities regularly show that ecological factors, such as the probability of extinction, often play a minor role in the decision-making process. The taxonomy of the species or its potential conflict with economic development is a more powerful factor. This paper presents quantitative empirical research on the protection of wetlands in Austria. Econometrically estimated models show that geographical and ecological factors (such as the size of the area, elevation and importance for biodiversity) play a significant role in the protection of wetlands. Additional influences include conflict variables encoding the negative effects of the primary economic sector (agriculture) or tourism.

Agriculture↗