Mental health cost of terrorism: Study of the Charlie Hebdo attack in ParisKim, Dongyoung; Albert Kim, Young‐I1
doi: 10.1002/hec.3520pmid: 28508452
This study examines whether a terrorist attack in a developed country, which does not cause major damage to its capital stocks, affects the mental health of its residents. By exploiting variations in survey dates of the European Social Survey, we use a difference‐in‐differences strategy to show that the attack adversely affects subjective well‐being and mental health measures of French respondents. These negative effects are stronger for immigrants and low‐income individuals. The impact is less dramatic for politically extreme right‐wing supporters. The distance from origin has little impact on these measures.
Can pay‐for‐performance to primary care providers stimulate appropriate use of antibiotics?Ellegård, Lina Maria; Dietrichson, Jens; Anell, Anders
doi: 10.1002/hec.3535pmid: 28685902
Antibiotic resistance is a major threat to public health worldwide. As the healthcare sector's use of antibiotics is an important contributor to the development of resistance, it is crucial that physicians only prescribe antibiotics when needed and that they choose narrow‐spectrum antibiotics, which act on fewer bacteria types, when possible. Inappropriate use of antibiotics is nonetheless widespread, not least for respiratory tract infections (RTI), a common reason for antibiotics prescriptions. We examine if pay‐for‐performance (P4P) presents a way to influence primary care physicians' choice of antibiotics. During 2006–2013, 8 Swedish healthcare authorities adopted P4P to make physicians select narrow‐spectrum antibiotics more often in the treatment of children with RTI. Exploiting register data on all purchases of RTI antibiotics in a difference‐in‐differences analysis, we find that P4P significantly increased the share of narrow‐spectrum antibiotics. There are no signs that physicians gamed the system by issuing more prescriptions overall.
Evaluation of a pharmaceutical risk‐sharing agreement when patients are screened for the probability of successMahjoub, Reza; Ødegaard, Fredrik; Zaric, Gregory S.
doi: 10.1002/hec.3522pmid: 28627808
We analyze a game‐theoretic model of a risk‐sharing agreement between a payer and a pharmaceutical firm. The drug manufacturer chooses the price while the payer sets the rebate rate and decides which patients are eligible for treatment. The manufacturer provides the payer with a rebate for nonresponding patients. We generalize on the existing literature, by making both price and rebate rate decision variables, allowing the rebate rate to be different from 100%, and incorporating 2 types of administrative costs. We identify a threshold for the expected probability of response for classifying the drug as a mass‐market or niche type and investigate the optimal solutions for both types. We also identify a threshold for the rebate rate at which the net benefits become equal for responding and nonresponding patients. Through numerical examples, we examine how various parameters impact the drug manufacturer's and the payer's optimal solution.
State insurance mandates and off‐label use of chemotherapySmieliauskas, Fabrice; Sharma, Hari; Hurley, Connor; Souza, Jonas A.; Shih, Ya‐Chen Tina
doi: 10.1002/hec.3537pmid: 28726348
Access to cancer drugs used off‐label is important to cancer patients but may drive up healthcare costs with little evidence of clinical benefit. We hypothesized that state health insurance mandates for private insurers to provide coverage for off‐label use of cancer drugs cause higher rates of off‐label use. We used Truven MarketScan data from 1999 to 2007 on utilization of 35 infused chemotherapy drugs in private health plans in the United States, covering the period when eight states implemented off‐label coverage laws. We studied trends in off‐label use of drugs, distinguishing between appropriate and inappropriate off‐label use according to drug compendia, and estimated difference‐in‐difference regressions of the effect of state laws on off‐label use. We estimate 41% of utilization was off‐label, including 17% of use conservatively defined as inappropriate. Trends show gradual declines in off‐label use over time. We also find no discernable effect of state laws mandating coverage of off‐label use of cancer drugs on utilization patterns under multiple empirical specifications. Our conclusion is that policymakers should consider shifting away from mandating coverage as a way to ensure access to drugs off‐label and towards incentivizing adherence to clinical practice guidelines to improve the quality and value of off‐label use.
Is there additional value attached to health gains at the end of life? A revisitGyrd‐Hansen, Dorte
doi: 10.1002/hec.3534pmid: 28568843
Researchers have in recent years sought to establish whether the general public value treatment at the end of life (EOL) more highly than other treatments. Results are mixed, with social preferences most often exhibiting lack of preferences for EOL treatments. This null result may be driven by the often applied study design, where respondents are to choose between treatments targeting patients with varying fixed life expectancies. When remaining life is certain and salient, a rule‐of‐rescue sentiment may drive preferences across all scenarios. This study presents a different design, where the comparator is a preventive intervention. We study preferences from both an individual and social perspective and find no preference for an EOL premium.
How should hospital reimbursement be refined to support concentration of complex care services?Bojke, Chris; Grašič, Katja; Street, Andrew
doi: 10.1002/hec.3525pmid: 28524248
The English National Health Service is promoting concentration of the treatment of patients with relatively rare and complex conditions into a limited number of specialist centres. If these patients are more costly to treat, the prospective payment system based on Healthcare Resource Groups (HRGs) may need refinement because these centres will be financially disadvantaged. To assess the funding implications of this concentration policy, we estimate the cost differentials associated with caring for patients that receive complex care and examine the extent to which complex care services are concentrated across hospitals and HRGs. We estimate random effects models using patient‐level activity and cost data for all patients admitted to English hospitals during the 2013/14 financial year and construct measures of the concentration of complex services. Payments for complex care services need to be adjusted if they have large cost differentials and if provision is concentrated within a few hospitals. Payments can be adjusted either by refining HRGs or making top‐up payments to HRG prices. HRG refinement is preferred to top‐payments the greater the concentration of services among HRGs.