SELECTED FOR YOU... APRIL 2011: books of the month - working papers

All the Selected for you

BOOKS OF THE MONTH

Introductory Econometrics : a modern approach.
Introduction à l'économétrie : une approche moderne.

Wooldridge J.M.
Mason : South-Western Cengage Learning : 2009 : 19p.-865 p.

The modern approach of this book recognizes that econometrics has moved from a specialized mathematical description of economics to an applied interpretation based on empirical research techniques. It bridges the gap between the mechanics of econometrics and modern applications of econometrics by employing a systematic approach motivated by the major problems facing applied researchers today. Throughout the content, the emphasis on examples gives a concrete reality to economic relationships and allows treatment of interesting policy questions in a realistic and accessible framework (4e de couverture).

WORKING PAPERS

Health Economics

Estimating the costs of specialised care.
Estimation des coûts des soins spécialisés.

Daidone S., Street A.
York : University of York : 2011/02 : 30 p.

This paper reports work undertaken for the Department of Health's Payment by Results (PbR) team to investigate whether: the costs associated with specialised activity are significantly different from non-specialised activity within the same Healthcare Resource Group (HRG) ; any differences in costs between specialised and non-specialised activity are due to differences in cost efficiency. This helps address the following PbR objectives: PbR gets the price ‘right' for services, by paying a price that ensures efficiency and value for money for the taxpayer, and incentivises the provision of care that is responsive to individual needs; The system is fair and transparent, through consistent fixed price payments to providers based on volume and complexity of activity. In broad terms, our analysis of data from 2008/9 explores whether patients who receive specialized services as part of their care package have higher costs than those who do not. If so, hospitals that treat more patients who receive specialised care might require top-up payments over and above their PbR tariff income. In our assessment we also take account of other factors that might explain costs. These factors include the Healthcare Resource Group (HRG) to which the patient is assigned, various sociodemographic, diagnostic and treatment-related characteristics of the patient, and the hospital in which the patient is treated. In what follows we first briefly set out the reasons why differential payments might be required for specialised services. We then describe how we identify patients as having received specialised care, assign costs to each patient record in HES, assess the costs of provider spells and decide upon an analytical sample. We specify our multiple regression models before providing some descriptive statistics comparing specialised to non-specialised activity. We then estimate models that investigate the extent to which variations in cost are explained by whether or not a patient received a specialized service.

The Long-term Impact of Medicare Payment Reductions on Patient Outcomes.
L'impact à long terme des réductions de paiement du Médicare sur l'état de santé des malades.

Wu V., Shen Y.S.
Cambridge : NBER : 2011/03 : 30p.

This study examines the long term impact of Medicare payment reductions on patient outcomes using a natural experiment - the Balance Budget Act (BBA) of 1997. We use predicted Medicare revenue changes due to BBA, with simulated BBA payment cuts as an instrument, to categorize hospitals by degrees of payment cuts (small, moderate, or large), and follow Medicare patient outcomes in these hospitals over a 11 year panel: 1995-1997 pre-BBA, 1998-2000 initial years of BBA, and 2001-2005 post-BBA years. We find that Medicare AMI mortality trends stay similar across hospitals when comparing between pre-BBA and initial-BBA periods. However, the effect became measurable in 2001-2005: hospitals facing large payment cuts saw increased mortality rates relative to that of hospitals facing small cuts in the post-BBA period (2001-2005) after controlling for their pre-BBA trends. We find support that part of the worsening AMI patient outcomes in the large-cut hospitals is explained by reductions in staffing level and operating cost following the payment cuts, and that in-hospital mortality is not affected partly due to patients being discharged earlier (shorter length-of-stay).

Health Status

Income inequality and population health: a panel data analysis on 21 developed countries.
Inégalités de revenu et état de santé de la population : une analyse de données de panel dans 21 pays développés.

Torre S., Myrskyla M.
Rostock : Max Planck Institute for Demographic Research : 2011/02 : 34 p.

The relative income-health hypothesis postulates that income distribution is one of the key determinants of population health. The discussion on the age and gender patterns of this association is still open. We test the relative income-health hypothesis using a panel data covering 21 developed countries for over 30 years. We find that net of trends in GDP per head and unobserved period and country factors, income inequality, measured by the Gini index, is strongly and positively associated with male and female mortality up to age 15. For women the association vanishes at older ages, but for men persists up to age 50. These findings suggest that policies decreasing income inequality may improve the health of children and young- to middle-aged men. The mechanisms behind the income inequality-mortality association are not known, but may be related to parental stress and male competition. Future research could focus on unravelling these mechanisms.

Medical Technology and the Production of Health Care.
Technologie médicale et la production de soins de santé.

Baltagi B.H., Moscone F., Tosetti E.
Bonn : IZA : 2011/03 : 21 p.

This paper investigates the factors that determine differences across OECD countries in health outcomes, using data on life expectancy at age 65, over the period 1960 to 2007. We estimate a production function where life expectancy depends on health and social spending, lifestyle variables, and medical innovation. Our first set of regressions include a set of observed medical technologies by country. Our second set of regressions proxy technology using a spatial process. The paper also tests whether in the long-run countries tend to achieve similar levels of health outcomes. Our results show that health spending has a significant and mild effect on health outcomes, even after controlling for medical innovation. However, its short-run adjustments do not seem to have an impact on health care productivity. Spatial spill overs in life expectancy are significant and point to the existence of interdependence across countries in technology adoption. Furthermore, nations with initial low levels of life expectancy tend to catch up with those with longer-lived populations.

Drugs

The Diversity of Concentrated Prescribing Behavior: An Application to Antipsychotics.
La diversité dans la concentration des modèles de prescription : Application aux médicaments antipsychotiques.

Levine Taub A., Kolotilin A., Gibbons R.S
Cambridge : NBER : 2011/02 : 44 p.

Physicians prescribing drugs for patients with schizophrenia and related conditions are remarkably concentrated in their choice among antipsychotic drugs. In 2007 the single antipsychotic drug prescribed by a physician accounted for 66% of all antipsychotic prescriptions written by that physician. Which particular branded antipsychotic was the prescriber's "favorite" varied widely across physicians, i.e. physician prescribing concentration patterns are diverse. Building on Frank and Zeckhauser's [2007] characterization of physician treatments varying from "custom made" to "ready-to-wear", we construct a model of physician learning that generates a number of hypotheses. Using 2007 annual antipsychotic prescribing behavior on 17,652 physicians from IMS Health, we evaluate these predictions empirically. While physician prescribing behavior is generally quite concentrated, prescribers having greater volumes, those with training in psychiatry, male prescribers, and those not approaching retirement age tend to have less concentrated prescribing patterns.

How do quality accounts measure up? Findings from the first year.
Comment peut on évaluer les comptes de la qualité ? Résultats de la première année de mise en oeuvre.

Foot C., Raleigh V., Ross S.
Londres : King's Fund Institute : 2010 : 36 p.

In 2010, for the first time, many providers of NHS services have been required to produce quality accounts, which are public reports of the quality of their services and their plans for improvement. We have analysed a sample of these, reviewing their compliance with statutory requirements and published guidance and assessing how well they meet principles of good practice in publishing information on quality. We looked in particular at: how they present and use quality measures to report on performance; how they have reported on data quality; their participation in clinical audit and national confidential enquiries; how providers have reported patient and public feedback; how they have involved local stakeholders, and what the external comments have focused on. Across all dimensions, there were examples of both good and poor practice, and many very different approaches to style, content and intended audience. Based on these findings, we have made a series of recommendations to providers about how their quality accounts could be improved. However, we also raise policy questions about quality accounts, in the context of the new government's policy agenda on information. We conclude that, fundamentally, quality accounts are so varied because they are having to provide commentary on a wide range of services, are serving a broad range of audiences and are also attempting to meet two related, but different, goals of local quality improvement and public accountability. The future for public accountability needs to focus more on the centralised provision of standard, consistent and comparable measures, published in forms that enable interpretation and comparison. Individual quality accounts can then both draw on these measures and select local priorities and measures, as long as those measures can be given with benchmark or trend information to provide some context for interpretation.

Health care policy

Method for Synthesizing Knowledge About Public Policies.
Méthode pour synthétiser la connaissance sur les politiques publiques.

Morestin F., Gauvin F.P, Hogue M.C.
Montréal : NCCHPP : 2011/02 : 53 p.

Parce que l'étude des politiques publiques soulève des défis particuliers, le Centre de collaboration national sur les politiques publiques et la santé a développé une méthode de synthèse de connaissances adaptée. Celle-ci permet de documenter les effets et l'équité des politiques étudiées ainsi que les enjeux d'application qui intéressent les décideurs (coûts, faisabilité, acceptabilité), en se basant sur la construction de modèle logique, sur les littératures scientifique et grise, et sur des processus délibératifs organisés pour recueillir de l'information contextuelle.

Health care system

Health, United States, 2010.
La santé aux Etats-Unis 2010.

US Department of Health and Human Services. Centers for Disease Control and Prevention. (C.D.C.).
Hyattsville : CDC - NCHS : 2011 : 587 p.

Monitoring the health of the American people is an essential step in making sound health policy and setting research and program priorities. In a Chartbook and detailed tables, this report provides an annual picture of the health of the entire Nation. It includes 41 charts, 148 detailed tables, and a Special Feature on Death and Dying.

Payment Reform Analysis of Models and Performance Measurement Implications.
Analyse des modèles de la réforme des paiements et implications sur la mesure de la performance.

Schneider E.C., Hussey P.S., Schnyer C.
Santa Monica : Rand corporation : 2010 : 276 p.

Insurers and purchasers of health care in the United States are on the verge of potentially revolutionary changes in the approaches they use to pay for health care. Recently, purchasers and insurers have been experimenting with payment approaches that include incentives to improve quality and reduce the use of unnecessary and costly services. The Patient Protection and Affordable Care Act of 2010 is likely to accelerate payment reform based on performance measurement. This technical report catalogues nearly 100 implemented and proposed payment reform programs, classifies each of these programs into one of 11 payment reform models, and identifies the performance measurement needs associated with each model. A synthesis of the results suggests near-term priorities for performance measure development and identifies pertinent challenges related to the use of performance measures as a basis for payment reform. The report is also intended to create a shared framework for analysis of future performance measurement opportunities. This report is intended for the many stakeholders tasked with outlining a national quality strategy in the wake of health care reform legislation.

Mental health and the productiviy challenge. Improving quality and value for money.
Santé mentale et le défi de la productivité. Améliorer la qualité et le rapport qualité prix.

Naylor C., Bell A.
Londres : King's Fund Institute : 2010 : 53 p.

The NHS is facing a significant financial challenge and needs to make substantial improvements in productivity if it is to provide high-quality services without additional funding. Spending on mental health accounts for around 10 per cent of the overall health budget and so the mental health sector has a key role in responding to this challenge. The King's Fund and Centre for Mental Health have worked together to explore how mental health services could be delivered in a different and more cost-effective way. The consensus from their work, including an expert seminar and a review of evidence, is that there is scope for mental health services not only to improve their own productivity but also to support productivity improvements in other parts of the NHS. This report focuses on four main areas: immediate priorities for improving productivity in existing mental health services, what mental health services can offer to improve productivity in the NHS as a whole, the economic benefits beyond the NHS of improved mental health care, the longer-term challenge of building a preventive and empowering mental health system. The report suggests that there are real opportunities to change the way mental health services are delivered in order to achieve more within existing budgets. Of the improvement areas highlighted in the report, we consider that the following are the most promising targets for immediate attention: reducing unnecessary bed use in acute and secure psychiatric wards, establishing systems to review the use of highly expensive out-of-area treatments, improving workforce productivity, strengthening the interface between mental and physical health care, particularly for older people and people with long-term conditions. Many case studies and practical examples are included to illustrate these conclusions, and there are recommendations for action that involve everyone in the health service.

Work and Health

Work Absenteeism Due to a Chronic Disease.
L'absentéisme au travail causé par les maladies chroniques

Lacroix G., Brouard M.E.
Laval : CIRPEE : 2011/02 : 30 p.

Research on health-related work absenteeism focuses primarily on moral hazard issues but seldom discriminates between the types of illnesses that prompt workers to stay home or seek care. This paper focuses on chronic migraine, a common and acute illness that can prove to be relatively debilitating. Our analysis is based upon the absenteeism of workers employed in a large Fortune-100 manufacturing firm in the United States. We model their daily transitions between work and absence spells between January 1996 up until December 1998. Only absence due to migraine and depression, its main comorbidity, are taken into account. Our results show that there is considerable correlation between the different states we consider. In addition, workers who are covered by the Blue Preferred Provided Organization tend to have shorter employment spells but also shorter migraine spells.

Ageing

Tracing the origins of successful aging. The role of childhood conditions and societal context.
Retrouver les origines du vieillissement réussi. Le rôle des conditions de vie durant l'enfance et du contexte sociétal.

Brandt M., Deindl C., Hank K.
Mannheim : MEA : 2011 : 19 p.

This study investigates the role of childhood conditions and societal context in older Europeans' propensity to age successfully, controlling for later life risk factors. Successful aging was assessed following Rowe and Kahn's conceptualization, using baseline interviews from the first two waves of the Survey of Health, Ageing and Retirement in Europe (SHARE). These data were merged with retrospective life-histories of participants from 13 Continental European countries, collected in 2008-09 as part of the SHARELIFE project. Our sample consists of 22,474 men and women, who are representative of the non-institutionalized population aged 50 or older (mean age: 63.3) in their respective country. Estimating multilevel logistic models, we controlled for demographics (age, sex), childhood conditions (SES, health, cognition), later life risk factors (various dimensions of SES and health behaviors), as well as country-level measures of public social expenditures and social inequality. There is an independent association of childhood living conditions with elders' odds of aging well. Higher parental SES, better math and reading skills, as well as self-reports of good childhood health were positively associated with successful aging, even if contemporary characteristics were controlled for. Later-life SES and health behaviors exhibited the expected correlations with our dependent variable. Moreover, higher levels of public social expenditures and lower levels of income inequality were associated with a greater probability to meet Rowe and Kahn's successful aging criterion. We conclude that unfavorable childhood conditions exhibit a harmful influence on individuals' chances to age well across all European welfare states considered in this study. Policy interventions should thus aim at improving the conditions for successful aging throughout the entire life-course.

Social capital and health of older Europeans from reverse causality to health inequalities.
Capital social et santé des Européens âgés.

Sirven N., Debrand T.
Paris : Irdes : 2011/02 : 24 p.

Les relations de causalité entre participation sociale (capital social) et santé des personnes âgées en Europe sont ici appréhendées à partir des trois vagues de l'enquête SHARE (Enquête sur la santé, le vieillissement et la retraite en Europe) dans 11 pays, auprès des individus de 50 ans et plus. Pour chacune des deux premières vagues (2004 et 2006), une série de variables renseigne sur la participation à des activités sociales (associations, clubs, partis politiques, etc.) et sur l'état de santé physique et mentale des répondants. Les données rétrospectives de la 3e vague d'enquête sur les histoires de vie (SHARELIFE) sont également prises en compte. Les résultats suggèrent que la participation sociale favorise une meilleure santé, et vice-versa. Néanmoins, l'effet de la santé sur la participation sociale apparaît plus important que l'effet inverse. Par conséquent, les individus âgés en bonne santé ont d'autant plus de chances de préserver leur santé grâce à l'effet bénéfique du capital social. De même, ceux en moins bonne santé ont moins de chances de participer à des activités sociales et ont donc une probabilité plus forte de voir leur état de santé se dégrader plus vite. En somme, malgré ses effets individuels bénéfiques, le capital social est un vecteur potentiel d'accroissement des inégalités de santé parmi les personnes âgées (Résumé d'auteur).