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SELECTED FOR YOU... JUNE 2010: books of the month - working papers

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BOOKS

Mirror, mirror on the wall : how the performance of the US health Care system compares internationally. 2010 update.
Miroir, miroir sur le mur : comment comparer la performance du système de santé américain à l'échelle internationale ? Mise à jour 2010.

Davis K., Schoen C., Stremikis K.
New York : The Commonwealth Fund : 2010 : 21 p.


Despite having the most costly health system in the world, the United States consistently underperforms on most dimensions of performance, relative to other countries. This report—an update to three earlier editions—includes data from seven countries and incorporates patients’ and physicians’ survey results on care experiences and ratings on dimensions of care. Compared with six other nations—Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom—the U.S. health care system ranks last or next-to-last on five dimensions of a high performance health system: quality, access, efficiency, equity, and healthy lives. Newly enacted health reform legislation in the U.S. will start to address these problems by extending coverage to those without and helping to close gaps in coverage—leading to improved disease management, care coordination, and better outcomes over time.




Value in Health Care: Accounting for Cost, Quality, Safety, Outcomes, and Innovation. Workshop Summary.
Valeur dans les soins de santé : rendre compte du coût, de la qualité, de la sécurité, des impacts et de l'innovation. Résumé du workshop.

The learning healthcare system series
Washington DC : The National Academies Press : 2010 : 263 p.


The United States has the highest per capita spending on health care of any industrialized nation. Yet despite the unprecedented levels of spending, harmful medical errors abound, uncoordinated care continues to frustrate patients and providers, and U.S. healthcare costs continue to increase. The growing ranks of the uninsured, an aging population with a higher prevalence of chronic diseases, and many patients with multiple conditions together constitute more complicating factors in the trend to higher costs of care. A variety of strategies are beginning to be employed throughout the health system to address the central issue of value, with the goal of improving the net ratio of benefits obtained per dollar spent on health care. However, despite the obvious need, no single agreed-upon measure of value or comprehensive, coordinated systemwide approach to assess and improve the value of health care exists. Without this definition and approach, the path to achieving greater value will be characterized by encumbrance rather than progress. To address the issues central to defining, measuring, and improving value in health care, the Institute of Medicine convened a workshop to assemble prominent authorities on healthcare value and leaders of the patient, payer, provider, employer, manufacturer, government, health policy, economics, technology assessment, informatics, health services research, and health professions communities. The workshop, summarized in this volume, facilitated a discussion of stakeholder perspectives on measuring and improving value in health care, identifying the key barriers and outlining the opportunities for next steps (4e de couverture).




Handbook of public policy evaluation.
Manuel d'évaluation de la politique publique.

Nagel S.S.
Thousand Oaks : Sage Publications : 2002 : 421 p.


Handbook of Public Policy Evaluation is the only book of its kind to present aspects of public policy evaluation that relate to economic, technology, social, political, international, and legal problems. Rather than looking at specific narrowly focused programs, this book emphasizes broad-based evaluation theory, study, and application, providing a rich variety of exceptional insights and ideas (4e de couverrture).





WORKING PAPERS

Health care system

Health Care Systems : Efficiency and Institutions.
Les systèmes de santé : efficacité et institutions.

Joumard I., Andre C., Nicq C.
Paris : OCDE : 2010/05 : 130 p.


Ce document présente un ensemble d’indicateurs afin d’évaluer la performance des systèmes de santé. Il présente aussi de nouvelles données comparatives sur les politiques et les institutions dans le domaine de la santé pour les différents pays de l’OCDE. Cet ensemble d’indicateurs permet de caractériser empiriquement les systèmes de santé en identifiant des groupes de pays ayant des politiques et institutions comparables. Il permet aussi de mettre en valeur les forces et les faiblesses du système de santé de chaque pays et de déterminer les gains potentiels d’efficacité. L’analyse empirique montre que dans chacun des pays étudiés l’efficacité des dépenses de santé peut être améliorée; qu’il n’existe pas de système qui, pour un coût donné, produit systématiquement des meilleurs résultats - des réformes radicales en faveur d’un système de santé ne sont donc pas nécessaires ; accroitre la cohérence des politiques en matière de santé en adoptant les politiques les plus performantes à l’intérieur d’un système similaire et en empruntant les éléments les plus appropriés aux autres systèmes s’avérera vraisemblablement plus réaliste et plus efficace pour améliorer l’efficacité de la dépense en matière de santé.


A New Era in American Health Care: Realizing the Potential of Reform.
Une nouvelle ère du système de santé américain : réaliser le potentiel de réforme.

Davis K.
New York : The Commonwealth Fund : 2010/06 : 27 p.


Through a pragmatic mix of public and private financing, the new Patient Protection and Affordable Care Act will expand health care coverage, establish health insurance exchanges with market rules that protect individuals and families, and begin to transform the health care system by encouraging greater value and efficiency through a series of payment and delivery system initiatives. In this report, Commonwealth Fund president Karen Davis outlines the key features of the new reform law, discusses who will be most helped and how, and describes the ways in which the health care system will begin to provide more patient-centered, accessible, and coordinated care to all Americans. Davis also discusses the challenges that will need to be overcome as the law’s provisions are implemented over the coming months and years.


Euro-Canada Health consumer index 2010.
Indice euro-canadien des consommateurs de soins de santé 2010.

Health Consumer Powerhouse. Bruxelles. BEL, Frontier Centre for Public Policy. (F.C.P.P.). Winnipeg. CAN
Winnipeg : Frontier Centre for Public Policy : 2010 : 48 p.


This is the third annual Euro-Canada Health Consumer Index (ECHCI). The ECHCI is an international comparison of healthcare system performance in 34 countries. All 27 European Union member states are examined, along with Norway, Switzerland, Croatia, FYR Macedonia, Iceland, Albania and Canada. For the third straight year, the Netherlands finishes in first place in the ECHCI, earning 857 out of 1,000 possible points.

Health care expenditures

The Challenge of Financing Health Care in the Current Crisis: An Analysis based on the OECD Data.
Le défi du financement des soins de santé durant la crise actuelle : une analyse basée sur des données de l'OCDE.

Scherer P., Devaux M.
Paris : OCDE : 2010/05 : 49 p.


La proportion des dépenses de santé par rapport au PIB, qui en termes macro-économiques est un indicateur récapitulant les besoins de financement d'un système de santé national, va probablement monter dans des pays où le PIB chute. Pendant les quatre dernières décennies, les dépenses de santé ont augmenté dans la plupart des pays plus rapidement que le PIB, menant à une hausse de la proportion des dépenses. Des fluctuations dans cette proportion peuvent survenir à la suite de variations dans l’une ou l’autre de ses composantes. Dans quelques cas, notamment aux États-Unis, la variation du PIB est à l'origine même de la différence du ratio, mais dans la majorité des pays, les variations de dépense de santé sont plus importantes. L'expérience des pays qui ont vraiment réduit leurs dépenses de santé après des récessions laisse à penser que de telles réductions sont de courte durée et que la demande de résultats en matière de services de la santé signifie à la longue une reprise de la croissance des dépenses de santé.


Guidelines for Improving the Comparability and Availability of Private Health Expenditures Under the system of Health Accounts Framework.
Recommandations pour l'amélioration de la comparabilité et la disponibilité des données sur les dépenses privées de santé dans le cadre du système des comptes de la santé.

Rannan-Eliya R., Lorenzoni L.
Paris : OCDE : 2010/05 : 61 p.


This paper reports on a project to improve the comparability and availability of private health expenditure under the joint health accounts questionnaire (JHAQ) data collection. The JHAQ is a framework for joint data collection in the area of health expenditure data developed by OECD, Eurostat, and WHO. In particular, the study questions were: How to overcome the inherent tendency for much private health care financing to occur without the generation of linked, reliable, and comprehensive routine data? How to tackle the issue of private providers likely to operate without reporting of routine data to statistical agencies?


Best practice in estimating the costs of alcohol – Recommendations for future studies.
Bonne pratique d'estimation des coûts de l'alcool. Recommandations pour les études futures.

Moller L., Matic S.
Copenhague : OMS Bureau Régional de l'Europe : 2010 : 64 p.


This report aims to summarize best practice in estimating the attributable and avoidable costs of alcohol, and to make recommendations for making such estimates in future studies. It discusses the conceptual basis for such cost studies, and then goes through the conceptual and methodological challenges for each type of cost in turn. It recommends (i) changes in the terminology used; (ii) the consistent and explicit consideration of ‘external’ costs (i.e. costs to others); (iii) more sophisticated modelling of the effect of policy interventions on costs; (iv) more robust attempts to quantify alcohol’s causal effect on harms and costs; (v) a demonstration project using new methodologies; (vi) the use of scenarios rather than existing sensitivity analyses; (vii) importing data from other studies rather than simply missing out certain types of cost; (viii) taking account of future health and resource costs; and (ix) not using the ‘human capital’ method for valuing the labour costs of premature mortality within the main estimates.

Health Status

Health Status Determinants in the OECD Countries. A Panel Data Approach with Endogenous Regressors.
Déterminants de l'état de santé dans les pays de l'OCDE. Une approche par données de panel utilisant des régresseurs endogènes.

Pocas A., Soukiazis E.
Coimbra : GEMF : 2010 : 24 p.


The purpose of this study is to analyse the determinants of life expectancy as proxy for health status of the OECD countries‘ population. A production function of health is used to explain life expectancy at birth for total and ageing population and according to gender. Socio-economic factors, health resources and lifestyles are defined as the main determinants of heath status. The estimation approach assumes that income and education are endogenous and a panel data approach is used to control for this problem. Our evidence shows that income, education and health resources (through consultations) are important factors affecting positively life expectancy and risky lifestyles (tobacco and alcohol consumption) are harmful to health. However there are differences between males and females. Income and lifestyles are the major determinants affecting men‘s health while for women education and the effective use of health services (through consultations) explain mostly life expectancy both at birth and late age.


Are Increasing 5-Year Survival Rates Evidence of Success Against Cancer? A reexamination using data from the U.S. and Australia.
L'augmentation des taux de survie au cancer dans les cinq ans est-elle la preuve du succès de la lutte contre le cancer ? Un réexamen de la situation sur la base des données américaines et australiennes.

Lichtenberg F.R.
Cambridge : NBER : 2010/06 : 17 p.


Previous investigators argued that increasing 5-year survival for cancer patients should not be taken as evidence of improved prevention, screening, or therapy, because they found little correlation between the change in 5-year survival for a specific tumor and the change in tumor-related mortality. However, they did not control for the change in incidence, which influences mortality and is correlated with 5-year survival. We reexamine the question of whether increasing 5-year survival rates constitute evidence of success against cancer, using data from both the U.S. and Australia. When incidence growth is controlled for, there is a highly significant correlation, in both countries, between the change in 5-year survival for a specific tumor and the change in tumor-related mortality. The increase in the relative survival rate is estimated to have reduced the unconditional mortality rate by about 15% in the U.S. between 1976 and 2002, and by about 15% in Australia between 1984 and 2001. While the change in the 5-year survival rate is not a perfect measure of progress against cancer, in part because it is potentially subject to lead-time bias, it does contain useful information; its critics may have been unduly harsh. Part of the long-run increase in 5-year cancer survival rates is due to improved prevention, screening, or therapy.

Hospital

An Integrative Model of the Management of Hospital Physician Relationships.
Un modèle intégré de management des relations entre praticiens hospitaliers.

Trybou J., Gemmel P., Annemans L.
Ghent : Ghent University : 2010 : 32 p.


Hospital Physician Relationships (HPRs) are of major importance to the health care sector. Drawing on agency theory and social exchange theory, we argue that both economic and noneconomic integration strategies are important to effective management of HPRs. We developed a model of related antecedents and outcomes and conducted a systematic review to assess the evidence base of both integration strategies and their interplay. We found that more emphasis should be placed on financial risk sharing, trust and physician organizational commitment.


Public Employment and Political Pressure: The Case of French Hospitals.
Emploi public et pression politique : le cas des hôpitaux français.

Clark A.E., Milcent C.
Bonn : IZA : 2010/06 : 40 p.


This paper uses an unusual administrative dataset covering the universe of French hospitals to consider hospital employment: this is consistently higher in public hospitals than in Not-For-Profit (NFP) or private hospitals, even controlling for a number of measures of hospital output. NFP hospitals serve as a benchmark, being very similar to Public hospitals, but without political influence on their hiring. Public-hospital employment is positively correlated with the local unemployment rate, whereas no such relationship is found in other hospitals. This is consistent with public hospitals providing employment in depressed areas. We appeal to the Political Science literature and calculate local political allegiance, using expert evaluations on various parties’ political positions and local election results. The relationship between public-hospital employment and local unemployment is stronger the more left-wing the local municipality.


Health of migrants - the way forward. Report of a global consultation.
Santé des migrants - aller de l'avant. Rapport d'une consultation globale.

Organisation Mondiale de la Santé. (O.M.S.). Genève. CHE, Ministry of Health and Social Policy. Madrid. SPA, International Organization for Migration (I.O.M.). Genève. CHE
Genève : OMS : 2010 : 112 p.


In a globalized world defined by profound disparities, skill shortages, demographic imbalances, climate change as well as economic and political crises, natural as well as man-made disasters, migration is omnipresent. There are an estimated 214 million international migrants, 740 million internal migrants and an unknown number of migrants in an irregular situation all over the world. While these figures comprise a wide range of different migrating populations, such as workers, refugees, students, undocumented migrants and others, and their vulnerability levels vary greatly, the collective health needs and implications of a population cohort of this size are considerable. The health of migrants and health matters associated with migration are crucial public health challenges faced by governments and societies.


Setting the political agenda to tackle health inequity in Norway.
Préparation d'un agenda politique pour s'attaquer aux inégalités de santé en Norvège.

Strand M., Brown C., Torgersen T.P., Giaever O.
Copenhague : OMS Bureau regional de l'Europe : 2009 : IV+62 p.


This report presents the Norwegian experience in implementing strategies to reduce socially determined health inequity and highlights the key lessons learned from this process. The report describes the introduction of a comprehensive intersectoral policy to tackle the social gradient in health and provides a tool to review progress to date and options for the future. Other countries can use and adapt the critical areas of learning to advance their own national policies, strategies and capacity to reduce socially determined health inequity.

Work and Health

Sickness Absence: a Pan-European Study.
Arrêts maladie : une étude pan-européenne.

Ilias L., Alexandos Z.
Munich : Munich Personal RepEc Archive : 2010/05 : 23 p.


This study, using the European Union Labour Force Survey, examines the determinants of sickness absence in 26 EU countries. The analysis highlights the importance of demographic and workplace characteristics and of institutional and societal conditions. Female workers aged 26-35 exhibit higher absenteeism, possibly reflecting the level of high household labour pressure. Increased job insecurity, captured by temporary contracts, and labour market uncertainty, reflected in higher unemployment rates, have a negative effect on absenteeism. Finally, individual sickness absence is lower in countries with higher proportion of dependent/out of the labour market individuals, probably because of the increasing pressure labour active people may experience.

Drugs

Generic drug pricing in Canada: components of the value-chain.
Prix des médicaments génériques au Canada : composants d'une chaîne de valeurs.

Hollis A.
Calgary : University of Calgary : 2010/01 : 32 p.


The problem of obtaining fair pricing for generic drugs has led to a series of regulatory measures in Canadian provinces. This paper offers a new way of thinking about the problems that need to be addressed, by considering three core components of the value chain of getting generic drugs to Canadians: litigation, production, and pharmacy services. The paper proposes that each component of this value chain should be paid for separately, using a royalty to reward successful litigation that benefits payers; a competitive market framework to pay for production; and a transparent, independent regulatory process to set dispensing fees for pharmacies. This approach would enable the total expenditures to match costs, would enable provinces to set appropriate quality and convenience standards for pharmacy, and would provide a measure of predictability for investors. The paper emphasizes that it is important to establish a separate mechanism for rewarding litigation that eliminates invalid patents. The savings to Canadians from such litigation exceeds one billion dollars annually. Without addressing the need to reward this valuable activity, it is dangerous for payers to drive down generic prices, since generic firms will lack incentives to invest in costly litigation. The paper also encourages governments to establish independent regulatory authorities to set fair fees for pharmacies by employing processes similar to those used in other price regulation agencies.

Health policy

Equity, social determinants and public health programmes.
Equité, déterminants sociaux et programmes en santé publique.

Blas E., Sivasankara Kurup A.
Genève : OMS : 2010 : 291 p.


This book is a collection of analyses of the social determinants of health that impact on specific health conditions. Stemming from the recommendations of the Commission on Social Determinants of Health, promising interventions to improve health equity are presented for the areas of: alcohol-related disorders, cardiovascular diseases, child health and nutrition, diabetes, food safety, maternal health, mental health, neglected tropical diseases, oral health, pregnancy outcomes, tobacco and health, tuberculosis, and violence and injuries. The book was commissioned by the Department of Ethics, Equity, Trade and Human Rights as part of the work undertaken by the Priority Public Health Conditions Knowledge Network of the Commission on Social Determinants of Health, in collaboration with 16 of the major public health programmes of WHO. In addition to this, through collaboration with the Special Programme of Research, Development and Research Training in Human Reproduction, the Special Programme for Research and Training in Tropical Diseases, and the Alliance for Health Policy and Systems Research, 13 case studies were commissioned to examine the implementation challenges in addressing social determinants of health in low-and middle-income settings.

Social protection

Complementing or replacing old age insurance ? The growing importance of funded pensions in the French pension system.
Compléter ou remplacer l'assurance vieillesse. L'importance croissante des fonds de pension dans le système de pension français.

Nacyk M., Palier B.
Edingburgh : Reconciling Work and Welfare in Europe. (R.E.C.W.O.W.E.) : 2010 : 42 p.


The French pension system has for long been characterised by its very low reliance on funded pensions, which have almost become a taboo subject since the Second World War. While other countries have often complemented statutory pensions with funded occupational pension schemes, in France, the social partners have put in place an encompassing network of supplementary pension arrangements financed on a pay-as-you-go (PAYG) basis. The generosity of these schemes and their defence by trade unions and part of the business community has considerably limited the room for expansion of funded pension schemes. However, the role played by these supplementary PAYG schemes has significantly changed over the last two decades. First, the gradual harmonization of rules within the different schemes and their compliance with EU social security regulations are leading to their quasi “first-pillarization”. Second, similar to statutory pensions, these schemes have also undergone gradual retrenchment and will offer reduced replacement rates. As a result, the development of pension savings has been implicitly promoted, although more on a voluntary basis than on a compulsory one. Despite a unification in the regulatory framework governing funded – occupational and personal – pension plans, access to these schemes remains mostly limited to high-skilled workers.


Mandatory Sick Pay Provision: A Labor Market Experiment.
Le dispositif obligatoire de prise en charge des indemnités journalières : une expérience sur le marché du travail.

Bauernschuster S., Duersch P., Oechssler J., Vadovic R.
Mannheim : University of Mannheim : 2010/03 : 24 p.


Sick-pay is a common provision in labor contracts. It insures workers against a sudden loss of income due to unexpected absences and helps them smooth consumption. Therefore, many governments find sick-pay socially desirable and choose to mandate its provision. But sick-pay is not without its problems. Not only it suffers from moral hazard but more importantly it is subject to a potentially serious adverse selection problem (higher sick-pay attracts sicker workers). In this paper we report results of an experiment which inquires to the extend and the severity of the adverse selection when sick-pay is voluntary versus when it is mandatory. Theoretically, mandating sick-pay may be effective in diminishing adverse selection. However, our data provide clean evidence that counteracting effects are more salient. Mandatory sick pay exacerbates moral hazard problems by changing fairness perceptions and, as a consequence, increases sick pay provision far above the mandatory levels.

Long-term care

Income and the Utilization of Long-Term Care Services: Evidence from the Social Security Benefit Notch.
Revenu et utilisation des services de soins de longue durée : évidence lors d'une réduction des prestations de sécurité sociale.

Goda G.S., Golberstein E., Grabowski D.C.
Cambridge : NBER : 2010/06 : 35 p.


This paper estimates the impact of income on the long-term care utilization of elderly Americans using a natural experiment that led otherwise similar retirees to receive significantly different Social Security payments based on their year of birth. Using data from 1993 and 1995 waves of the AHEAD, we estimate instrumental variables models and find that a positive permanent income shock lowers nursing home use but increases the utilization of paid home care services. We find some suggestive evidence that the effects are due to substitution of home care for nursing home utilization. The magnitude of these estimates suggests that moderate reductions in post-retirement income would significantly alter long-term utilization patterns among elderly individuals.

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July 5th, 2010