journal article
LitStream Collection
Home
Richardson, Jeffrey; Crowley, Steven
doi: 10.1002/hec.4730030204pmid: 8044214
This paper considers alternative approaches to the evaluation of the total cost of alcohol consumption in Australia. It calculates the impact of alternative tax rates on beer, wine and spirits separately and the ‘consumption cost’ of these taxes in terms of the distortion caused to consumption patterns. Two separate analyses are carried out. First optimal taxation is calculated which minimises the total loss from the ‘consumption cost’ of taxation plus the external cost of alcohol consumption. Secondly, the benefits of life are separated from other benefits and the impact of tax expressed in terms of the cost per life year gained. Conceptualised in this way, the results of this ‘tax’ program may be expressed in the same way as other health programs, namely as a net cost per life year gained. Alcohol taxation may then be compared with other life saving interventions. The chief conclusion reached is that in Australia there is a very compelling case for a new tax base and for a very significant increase in the rate of alcohol taxation.
doi: 10.1002/hec.4730030205pmid: 8044215
The paper examines different interpretations of the QALY concept. It is suggested that the QALY interpreted as a measure of amounts of well‐life does not carry sufficient empirical meaning. As a measure of individuals' personal appreciation of outcomes in their own lives the QALY does not seem to work in comparisons of life saving interventions with interventions that improve health or increase life expectancy. For the QALY to be a generally empirically meaningful concept, it looks as though it needs to be interpreted as a measure of social value. This conclusion has direct implications for how values for health states should be elicited.
Briggs, Andrew; Sculpher, Mark; Buxton, Martin
doi: 10.1002/hec.4730030206pmid: 8044216
Given the increased use of economic evaluation to inform decision making in the health service, it is particularly important that the research methods used are critically assessed and, where possible, improved. The systematic handling of uncertainty in economic evaluation is an important area that remains methodologically underdeveloped. With the increased use of the clinical trial as a vehicle for economic evaluation, there has been recent interest in how the statistical methods routinely employed to handle uncertainty in clinical research might be applied to economic evaluation. This paper reviews the types of uncertainty that exist in economic evaluation and argues that some forms of uncertainty are not amenable to statistical methods. Sensitivity analysis is not a single approach but can take a number of different forms. The different types of sensitivity analysis are reviewed, with an indication of their strengths and weaknesses in relation to the different types of uncertainty in economic evaluation.
Benzeval, Michaela; Judge, Ken
doi: 10.1002/hec.4730030207pmid: 8044211
Since 1976 various attempts have been made to ensure that NHS resources available for hospital and related services in England are allocated in proportion to the health care needs of different areas. The current method is based on analyses of the links between observed patterns of in‐patient utilization and the characteristics of the populations of small areas. There are a number of practical difficulties with this approach, however, and so the search continues for new analytical techniques. The purpose of this paper is to explore how household survey data about 12,729 English adults could be used to inform resource allocation decisions. Health care need indicators can be developed based on Census information and odds ratios derived from logistic regression analyses of the relationships between hospital utilization, health status, socio‐demographic characteristics and area indicators of supply. The results suggest that health status is the most important determinant of hospital utilization, although demographic and socio‐economic factors also have some influence. In addition to the personal characteristics of individual respondents, area correlates of health care supply are also positively associated with reported utilization. The final part of the paper illustrates how weighted population estimates might be calculated on the basis of empirically‐derived indicators of health care need.
doi: 10.1002/hec.4730030208pmid: 8044212
Among the target‐linked services introduced by the 1990 general practitioners' contract, childhood immunization in Scotland is the best suited for GPs to achieve the high target, given a centralized call and recall system and public confidence in the service. Yet over 25% of the practices in the area of the Greater Glasgow Health Board did not qualify for the high target payments in the last quarter of the 1991/92 financial year. Examining indicators of the socioeconomic characteristics of the patient population, practice profiles and the effect of financial incentives, we discuss the reasons for cross‐practice variation in the uptake of this service and estimate the probability of practices which missed the high target achieving it in the future.
Showing 1 to 10 of 13 Articles