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SELECTED FOR YOU... APRIL 2010: working papers

All the Selected for you

WORKING PAPERS

Health care systems

Preferences for Health Insurance in Germany and the Netherlands : A Tale of Two Countries.
Les préférences en assurance maladie pour l'Allemagne et les Pays-Bas : un rapport sur deux pays.

Zweifel P., Leukert K., Berner S.
Zurich : University of Zurich : 2010/03 : 26 p.


This contribution contains an international comparison of preferences. Using two Discrete Choice Experiments (DCE), it measures willingness to pay for health insurance attributes in Germany and the Netherlands. Since the Dutch DCE was carried out right after the 2006 health reform, which made citizens explicitly choose a health insurance contract, two research questions naturally arise. First, are the preferences with regard to contract attributes (such as Managed-Care-type restrictions of physician choice) similar between the two countries? Second, was the information campaign launched by the Dutch government in the context of the reform effective in the sense of reducing status quo bias? Based on random-effects Probit estimates, these two questions can be answered as follows. First, while much the same attributes have positive and negative willingness to pay values in the two countries, their magnitudes differ, pointing to differences in preference structure. Second, status quo bias in the Netherlands is one-half of the German value, suggesting that Dutch consumers were indeed made to bear the cost of decision making associated with choice of a health insurance contract.


Competition Between HMO and PPO: A Two-Sided Market Approach.
Concurrence entre HMO et PPO : une approche duale du marché.

Bardey D., Rochet J.C.
Rochester : Social Science Electronic Publishing : 2009/12 : 17 p.


Classical analysis of health insurance markets often focuses on adverse selection, which creates a direct externality between the enrollees of the same health plan: under an imperfect risk adjustment, the higher the risks of my co-enrollees, the higher my cost of insurance. This has lead to the view that restricting the diversity of accessible physicians may be good for policyholders, in a context where competition between health plans can lead to a "death spiral" for the less restrictive plan. This paper defends the opposite view that diversity might pay, because of the indirect externality between policyholders and physicians. By attracting higher risks, the less restrictive plan may also guarantee a higher level of activity to its physicians, and therefore negotiate with them a lower fee-for-service rate. By explicitly modeling the two sides of the market for health (policyholders and physicians), we are able to find examples in which competition between health plans gives a higher profit to the less restrictive plan.


The Effect of Health Insurance Coverage on the Use of Medical Services.
L'effet de la couverture d'assurance maladie sur le recours aux services médicaux.

Anderson M., Dobkin C., Gross T.
Cambridge : NBER : 2010/03 : 41 p.


Substantial uncertainty exists regarding the causal effect of health insurance on the utilization of care. Most studies cannot determine whether the large differences in healthcare utilization between the insured and the uninsured are due to insurance status or to other unobserved differences between the two groups. In this paper, we exploit a sharp change in insurance coverage rates that results from young adults “aging out” of their parents’ insurance plans to estimate the effect of insurance coverage on the utilization of emergency department (ED) and inpatient services. Using the National Health Interview Survey (NHIS) and a census of emergency department records and hospital discharge records from seven states, we find that aging out results in an abrupt 5 to 8 percentage point reduction in the probability of having health insurance. We find that not having insurance leads to a 40 percent reduction in ED visits and a 61 percent reduction in inpatient hospital admissions. The drop in ED visits and inpatient admissions is due entirely to reductions in the care provided by privately owned hospitals, with particularly large reductions at for profit hospitals. The results imply that expanding health insurance coverage would result in a substantial increase in care provided to currently uninsured individuals.

Health policy

A liberal dose? Health and wellbeing: the role of the state.
Une dose de libéralisme ? Santé et bien être : le rôle de l'Etat.

Reeves R.
Londres : Department of Health : 2010/01 : 50 p.


The role of the state in health and wellbeing is a complex and controversial issue. A difficult question for any government is how far to intervene in the choices and behaviour of individuals in order to promote their own, or others’, health. Good health is a vital ingredient of a good life – but so is freedom. This report sets out evidence for what the public think about this question, explores the key issues at stake and clarifies principles for state intervention, suggests a new framework to guide decision making; and proposes a new narrative for future state intervention.


Influencing public behaviour to improve health and wellbeing.
Influencer le comportement du public pour améliorer la santé et le bien être.

Mulgan G.
Londres : Department of Health : 2010/01 : 40 p.


This independent report builds on current approaches, using the latest evidence from areas such as behavioural economics and psychology, to suggest ways in which the Government could become more effective in this area, to help people to make healthier choices where they wish to do so.


Enabling effective delivery of health and wellbeing.
Permettre une offre de soins de santé et de bien être efficace.

Bernstein H., Cosford P., Williams A.
Londres : Department of Health : 2010/01 : 45 p.


This independent report offers recommendations to the Secretary of State on how better to enable the delivery of improved health and wellbeing. The terms of reference for this report requested an assessment of the current opportunities and barriers in delivery systems, to identify where practical changes could be made to improve effectiveness.


The impact of the NHS market: an overview of the literature.
Un panorama de la littérature concernant l'impact du NHS orienté vers le marché

Brereton L., Vasoodaven V.
Londres : Civitas : 2010/02 : 60 p.


NHS ‘internal’ or ‘quasi’ market policies in England have aimed to promote competition among providers in the hope of replicating the benefits markets have been known to bring about in the private sector: decreases in cost, and increases in efficiency, quality, innovation, and provider responsiveness. This briefing presents the results of a large-scale literature search on the effectiveness of these policies over the past 20 years.

Quality of care

Getting the measure of quality.
Prendre la mesure de la qualité.

Raleigh V.S., Foot C.
Londres : King's Fund Institute : 2010 : 32 p.


Quality has been at the centre of recent NHS policy, and the NHS Next Stage Review highlighted the role of information and measurement in supporting quality improvement, particularly in relation to patient safety, clinical effectiveness and patient experience. It is therefore important to be clear how quality can be measured and by whom – and how the information can be used to improve services. If quality measurement is going to have greatest impact, all those involved – policy-makers, commissioners, board members, managers and clinicians – need to be aware of the opportunities and challenges it presents. This report offers information about how quality is defined and how quality measures can be used – and misused. It sets out the main debates and choices faced by those involved in measuring and using data on quality and outlines some practical issues to be considered in choosing and using quality measures.


Quality of Healthcare in Canada: A Chartbook.
La qualité des services de santé au Canada en graphiques.

Sutherland K., Leatherman S.
Ottawa : Canadian Health Services Research Foundation. : 2010/01 : 239 p.


The Canadian Health Services Research Foundation has released Canada’s first-ever chartbook on healthcare quality. Providing both domestic and international data, the chartbook reports on six key domains of quality: the effectiveness of the healthcare sector; access to healthcare services; the capacity of systems to deliver appropriate services; the safety of care delivered; the degree to which healthcare in Canada is patient-centred; and equity in healthcare outcomes and delivery.


Effective Governance for Quality and Patient Safety in Canadian Healthcare Organizations.
Une gouvernance efficace pour la qualité et la sécurité des patients dans les organismes de santé au Canada.

Ross Baker G., Denis J.L., Pomey M.P., Macintosh-Murray A.
Ottawa : Canadian Health Services Research Foundation. : 2010/01 : 239 p.


Commissioned by the Canadian Health Services Research Foundation in partnership with the Canadian Patient Safety Institute, this report, prepared by a team of researchers led by Ross Baker, explores the structures, processes and tools used by effective governing boards of healthcare organizations, and the strategies and tactics that can be employed by boards in their efforts to improve governance for quality and patient safety. The report also offers recommendations for board members and executives of healthcare organizations and for policy makers.

Hospital

The Impact of Competition on Management Practices in Public Hospitals.
L'impact de la concurrence sur les pratiques managériales dans les hôpitaux publics.

Bloom N., Propper C., Seiler S. Van Reenen J.
Bruxelles : KCE : 2010 : 2 vol (143 ; 293 p.)


We exploit a unique dataset and natural experiment to identify the impact of competition on public hospital management practices. We use a new double-blind management scoring tool to interview 161 physicians and managers in English National Health Service (NHS) hospitals, covering 61% of acute hospitals. We find this management measure is strongly correlated with hospital performance as measured by clinical outcomes (e.g. survival rates from heart attacks) and general operational and financial outcomes. We then instrument the number of competing local public hospitals with the share of marginal local political constituencies. In the UK the Government almost never closes public hospitals in political marginals because they risk losing seats in a general election. But they do regularly close hospitals in both their own and the oppositions non-marginal constituencies. Over the period we study the Labor government closed a large number of hospitals, leading to wide variations in hospital concentration levels, which are strongly correlated with whether the constituency was politically marginal. Exploiting this identification we find that product market competition, as proxied by the proximity of other hospitals, is significantly associated with better management.

Health inequalities

Reducing the Risks to Health: The Role of Social Protection Report of the Social Protection Task Group for the Strategic Review of Health Inequalities in England Post 2010.
Réduire les risques liés à la santé : le rôle du rapport du groupe de travail sur la protection sociale dans la revue stratégique des inégalités de santé en Angleterre après 2010.

Glennerster H.
Londres : LSE : 2009/06 : 46 p.


We demonstrate that the introduction of social protection systems as well as their generosity and coverage have significant impacts on health. Who receives the benefits within the household affects the health outcomes for the family. The eligibility for and administration of benefits matters. We examine the growth of means testing in the UK and its recent modifications. We find serious difficulties facing those with long term medical conditions who are on the margins of the labour force. Collaboration between the health and social protection systems is poor. We give particular attention to gender and health and the implications this has for the social protection system. We also consider the fate of groups like asylum seekers who are excluded from its normal working.


Fair Society, Healthy Lives. The Marmot Review Final Report.
Une sociéte juste, des vies en bonne santé : rapport final de la revue Marmot.

Marmot M.
Londres : University College of London : 2010 : 238 p.


In November 2008, Professor Sir Michael Marmot was asked by the Secretary of State for Health to chair an independent review to propose the most effective evidence-based strategies for reducing health inequalities in England from 2010. The strategy will include policies and interventions that address the social determinants of health inequalities. The Review had four tasks : Identify, for the health inequalities challenge facing England, the evidence most relevant to underpinning future policy and action; Show how this evidence could be translated into practice Advise on possible objectives and measures,,building on the experience of the current PSA target on infant mortality and life expectancy ; Publish a report of the Review’s work that will contribute to the development of a post- 2010 health inequalities strategy.


Measuring the impact of health insurance on levels and trends in inequality.
Mesurer l'impact de l'assurance santé sur les niveaux et les tendances en matière d'inégalité.

Burkhauser R.V., Simon K.I.
Cambridge : NBER : 2010/03 : 38 p.


A substantial part of the inequality literature in the United States has focused on yearly levels and trends in income and its distribution over time. Recent findings in that literature show that median income appears to be stagnating with income growth primarily coming at higher income levels. But the value of health insurance is an important and growing source of economic well being for American households that is missed by focusing solely on income. In this paper we take estimates of the value of different types of health insurance received by households and add them to usual pre tax post transfer measures of income from the Current Population Survey's March Annual Demographic Supplement for income years 1995-2008 to investigate their impact on levels and trends in measured inequality. We show that ignoring the value of health insurance coverage will substantially understate the level of economic well being of Americans and its upward trend and overstate the level of inequality and its upward trend. As an application of our fuller measure of income, we consider how two provisions of current health reform proposals to expand health insurance affect the level and distribution of economic well being.

Long-term care

Long-Term Care Financing Reform: Lessons from the U.S. and Abroad.
La réforme du financement des soins de longue durée : leçons des Etats-Unis et de l'étranger.

Gleckman H.
New York : The Commonwealth Fund : 2010/02 : 33 p.


As part of health care reform, Congress is considering the Community Living Assistance Services and Supports (CLASS) Act. The measure would mark the most significant change since 1965 in the way the U.S. finances long-term care, the personal assistance delivered both at home and in nursing facilities to the frail elderly and other adults with disabilities. As policymakers consider the CLASS Act, they may be able to learn from past experiments in the U.S. as well as from the experiences of other major industrialized countries, most of which have migrated to universal, government-run financing systems. Although those models vary markedly in their specifics, they appear to be both broadly popular and somewhat more costly than expected. By contrast, the CLASS Act is a voluntary system that attempts to meld public insurance with private long-term care coverage and Medicaid.

Primary health care

Accessibility and continuity of care : a study of primary healthcare in Quebec.
L’accessibilité et la continuité des services de santé : une étude sur la première ligne au Québec.

Pineault R., Levesque J.F., Roberge D., Hamel M., Lamarche P., Haggerty J.
Québec : INSPQ : 2009/03 : ix+86 p.


Cette étude, menée dans deux régions socio-sanitaires du Québec, Montréal et la Montérégie, porte sur les modèles d’organisation des services médicaux de première ligne et leur influence sur l’accessibilité et l’utilisation des services de santé par la population ainsi que sur l’expérience de soins des utilisateurs des services. Le principal but de l’étude est d’identifier les modèles d’organisation des services de première ligne les mieux adaptés et les plus prometteurs pour répondre aux besoins et aux attentes de la population.


Primary Care and Emergency Departments.
Soins primaires et services d'urgence.

Carson D., Clay H., Stern R.
Londres : Primary Care Foundation : 2010/03 : 102 p.


The Primary Care Foundation was commissioned by the UK Department of Health in May 2009 to carry out a study across England of the different models of primary care operating within or alongside emergency departments. The aim was to provide a viable estimate of the number of patients who attend emergency department with conditions that could be dealt with elsewhere in primary care.

Medical technologies

Achieving Efficiency Improvements in the Health sector through ICTs - Final report.
La réalisation de gains d’efficience dans le secteur de la santé au moyen des technologies de l’information et de la communication.

Organisation de coopération et de développement économiques. (OCDE). Directorate for Employment - Labour and Social Affairs. (D.E.L.S.A.). Paris. FRA
Paris : OCDE : 2010 : 117 p.


This report presents an analysis of OECD countries’ efforts to implement information and communication technologies (ICTs) in health care systems. It provides advice on the range of policy options, conditions and practices that policy makers can adapt to their own national circumstances to accelerate adoption and effective use of these technologies. The analysis draws upon a considerable body of recent literature and in, particular, lessons learned from case studies in six OECD countries (Australia, Canada, the Netherlands, Spain, Sweden, and the United States), all of which reported varying degrees of success deploying health ICT solutions.

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April 7th, 2010