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SELECTED FOR YOU... OCTOBER 2007: book of the month - working papers

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BOOK

Costs of occupational injuries and illnesses.
Coûts des accidents et des maladies professionnelles.

Leigh J.P., Markowitz S., Fahs M., Landrigan P. Ann Arbor : The University of Michigan Press : 2003 : 13-310 p.

Most of us between the ages of 22 and 65 spend 40 to 50, percent of our warking hours at work. Every year, million of us suffer injuries, diseases, and deaths in our workplaces. Yet little effort has been made to estimate either the extent of these injuries, deaths, and diseases or their cost to the economy. Thus, important questions about workplace safety and the economic resources expended due to workplace health problems remain unanswered. In this study, we address these questions by presenting estimates of the incidence, prevalence, and costs of workplace-related injuries, illnesses, and deaths for the entire civilian workforce of the United States in 1992. This book also considers controversies surrounding cost methodologies, estimate how these costs are distributed across occupations, consider who pays the costs, and address some policy issues.

WORKING PAPERS

Health Economics

Forecasting the global burden of Alzheimer's disease

Prévoir le fardeau global de la maladie d'Alzheimer.

Brookmeyer R., Johnson E., Ziegler-Graham K., Arrighi H.M.

Baltimore : John Hopkins University : 2007 : 22 p.

The goal was to forecast the global burden of Alzheimer’s disease and evaluate the potential impact of interventions that delay disease onset or progression. Methods: A stochastic multi-state model was used in conjunction with U.N. worldwide population forecasts and data from epidemiological studies on risks of Alzheimer’s disease. Findings: In 2006 the worldwide prevalence of Alzheimer’s disease was 26.6 million. By 2050, prevalence will quadruple by which time 1 in 85 persons worldwide will be living with the disease. We estimate about 43% of prevalent cases need a high level of care equivalent to that of a nursing home. If interventions could delay both disease onset and progression by a modest 1 year, there would be nearly 9.2 million fewer cases of disease in 2050 with nearly all the decline attributable to decreases in persons needing high level of care. Interpretation: We face a looming global epidemic of Alzheimer’s disease as the world’s population ages. Modest advances in therapeutic and preventive strategies that lead to even small delays in Alzheimer’s onset and progression can significantly reduce the global burden of the disease.

An analysis of the impact of age and proximity of death on health care costs in Ireland

Analyse de l'impact de l'âge et la proximité du décès sur les coûts des soins de santé en Irlande.

Layte R.

Organisation de coopération et de développement économiques. (OCDE). Dublin : ESRI : 2007/05 : 15 p.

Research has shown that older individuals are far more likely to avail of health care and there is concern in a number of countries that the trend toward population ageing may mean that health care expenditures increase to unsustainable levels. However, there is a growing body of evidence that the approach of death rather than age per se may be the main determinant of health care costs. Previous analyses of the relationship between proximity to death and costs have used rare longitudinal data on costs and whether died and none have used a national sample. In this paper we use a more commonly found data type – a national panel survey to show that proximity to death is indeed a more significant predictor of expenditure on GP and hospital services than age. Using random effects panel models we show that there is a significant gradient in costs as death approaches. Controlling for proximity to death there is no age gradient in costs. This conclusion remains unchanged adjusting for differential health inpatient costs across age groups. In fact, adjustment steepens the gradient in costs as death approaches.

Pharmaceuticals

Market effects of generic entry : the role of physicians and of non-bioequivalent competitors

Les effets de marché lors de l'entrée d'un médicament générique : rôle des médecins et des produits concurrents non bio-équivalents.

Gonzales J., Sismeiro C., Dutta S., Stern P.

Munich : Munich Personal RepEc Archive : 2007/06 : 39 p.

Patent expiration represents a turning point for the brand losing patent protection as bioequivalent generic versions of the drug quickly enter the market at reduced prices. In this paper, we study how physician characteristics and their prescribing decisions impact the competition among molecules of a therapeutic class, once generic versions of one of these molecules enter the market. Specifically, we study the evolution of the Selective Serotonine Reuptake Inhibitors (SSRIs) after the introduction of generic versions of fluoxetine (brand name Prozac) in the United Kingdom (UK). Our results suggest that, to fully understand the market evolution after generic entry, public health officials need to consider the marketing activities of pharmaceutical companies and determine how (1) individual physicians prescribe all competing drugs, and (2) respond to drug prices and marketing actions. For example, we find that a group of physicians sensitive to detailing switch from fluoxetine to nonbioequivalent branded alternatives after patent expiration, as Prozac significantly reduces its marketing support. Consequently, the market share of fluoxetine decreases despite being available at significant price discount under generic form, and despite the increase of prescriptions by price-sensitive physicians. Hence, governments interested in assessing generics diffusion should consider the prescribing across all competitors, whether or not bioequivalent, and determine the size of physician segments sensitive to pharmaceutical marketing activity and prices.

The impact of patenting on new product introductions in the pharmaceutical industry

L'impact du brevet sur l'introduction de nouveaux médicaments dans l'industrie pharmaceutique.

Stuart G., Matthew H.

Munich : University library of Munich : 2007/08 : 43 p.

Since Comanor and Scherer (1969), researchers have been using patents as a proxy for new product development. In this paper, we reevaluate this relationship by using novel new data. We demonstrate that the relationship between patenting and new FDA-approved product introductions has diminished considerably since the 1950s, and in fact no longer holds. Moreover, we also find that the relationship between R&D expenditures and new product introductions is considerably smaller than previously reported. While measures of patenting remain important in predicting the arrival of product introductions, the most important predictor is the loss of exclusivity protection on a current product. Our evidence suggests that pharmaceutical firms are acting strategically with respect to new product introductions. Finally, we find no relationship between firm size and new product introductions

Social protection

Does free supplementary health insurance help the poor to access health care ? Evidence from France

La gratuité de l'assurance complémentaire aide-t-elle à l'accès aux soins des populations défavorisées ? Evidence issue de l'expérience française.

Grignon M., Perronnin M., Lavis J.N.

Ontario : McMaster University : 2006 : 37 p.

The French government introduced a "free supplementary health insurance plan" in 2000, which covers most of the out-of-pocket payments faced by the poorest 10% of French residents. This plan was designed to help the non-elderly poor to access health care. To assess the impact of the introduction of the plan on its beneficiaries, we use a longitudinal dataset to compare, for the same individual, the evolution of his/her expenditures before and after enrolment in the plan. This longitudinal analysis allows us to remove most of the spuriousness due to individual heterogeneity, and we also use information on past coverage to evaluate the impact of specific benefits associated with the plan. As a result, we can properly assess the impact of the plan on those who enrolled in it. However, we cannot assess the impact of the plan on all of those who were eligible to enrol. Our main result is the plan’s lack of an overall effect on utilization. This result is likely attributable to the fact that those who were enrolled automatically in the free plan (the majority of enrollees), already benefited from a relatively generous plan. The significant effect among those who enrolled voluntarily in the free plan was likely driven by those with no previous supplemental coverage.

Primary health care

Service motives and profit incentives among physicians

Godager G., Iversen T.

Boston : Université de Boston : 2007/04 : 36 p.

We model physicians as health care professionals who care about their services and monetary rewards. These preferences are heterogeneous. Different physicians trade off the monetary and service motives differently, and therefore respond differently to incentive schemes. Our model is set up for the Norwegian health care system. First, each private practice physician has a patient list, which may have more or less patients than he desires. The physician is paid a fee-for-service reimbursement and a capitation per listed patient. Second, a municipality may obligate the physician to perform 7.5 hours per week of community services. Our data are on an unbalanced panel of 435 physicians, with 412 physicians for the year 2002, and 400 for 2004. A physician’s amount of gross wealth and gross debt in previous periods are used as proxy for preferences for community service. First, for the current period, accumulated wealth and debt are predetermined. Second, wealth and debt capture lifestyle preferences because they correlate with the planned future income and spending. The main results show that both gross debt and gross wealth have negative effects on physicians’ supply of community health services. Gross debt and wealth have no effect on fee-for-service income per listed person in the physician’s practice, and positive effects on the total income from fee-for-service; hence, the higher income from fee-for-service is due to a longer patient list. Patient shortage has no significant effect on physicians’ supply of community services, a positive effect on the fee-for-service income per listed person, and no effect on the total income from fee-for service. These results confirm physician preference heterogeneity.

Rationing the public provision of healthcare in the presence of private supplements : evidence from the italian NHS

Le rationnement de l'offre de soins publique en présence d'offres de soins privées : à propos de l'expérience du système de santé italien

Fabbri D., Monfardini C.

Turin : CHILD : 2006/11 : 30 p.

In this paper we assess the relative effectiveness of user charges and administrative waiting times as a tool for rationing public healthcare in Italy. We measure demand elasticities by estimating a simultaneous equation model of GP primary care visits, public specialist consultations and private specialist consultations, as if they were part of an incomplete system of demand. We find that own price elasticity of the demand for public specialist consultation is about -0.3, while administrative waiting time plays a less important role. No substitution exists between the demand for public and private specialists, so that user charges act as a net deterrent for over-consumption. The public provision of healthcare does not induce the wealthy to opt out. Moreover our evidence suggests that user charges and waiting lists do not serve redistributive purposes.

Health systems

Measurement of horizontal inequity in health care utilization using European panel

Mesure de l'inéquité horizontale dans le recours aux soins. Résultats issus d'un panel européen

Bago d'Uva T., Jones A.M., Van Doorslaer E.

Amsterdam : Tinbergen Institute : 2007 : 28 p.

Measurement of inequity in health care delivery has focused on the extent to which health care utilization is or is not distributed according to need, irrespective of income. Studies using cross-sectional data have proposed various ways of measuring and standardizing for need, but inevitably much of the inter-individual variation in needs remains unobserved in cross-sections. This paper exploits panel data methods to improve the measurement by including the time-invariant part of unobserved heterogeneity into the need-standardization procedure. Using latent class hurdle models for GP and specialist visits estimated on 8 annual waves of the European Community Household Panel we compute indices of horizontal equity that partition total income-related variation in use into a need- and a non-need related part, not only for the observed but also for the unobserved but time-invariant component. We also propose and compare a more conservative index of horizontal inequity to the conventional statistic. We find that many of the cross-country comparative results appear fairly robust to the panel data test, although the panel based methods lead to higher estimates of horizontal inequity for most countries. This confirms that better estimation and control for need often reveals more pro-rich distributions of utilization.

Planning and market regulation : strengths, weaknesses and interactions in the provision of less inequitable and better quality health care : a literature review

Planification et régulation : forces, faiblesses et interactions pour la production d'une moindre inéquité et d'une meilleure qualité des soins : revue de la littérature

Mackintosh M.

Johannesburg : University of the Witwaterstrands : 2007/03 : 52 p.

This paper argues that planned health care provision and market regulation play distinct roles in relation to the effective provision of equitable health care. Governmental planned provision has a core objective ensuring that health system is redistributive and that the poor have access to competent care. Market regulation has as its central objective the shaping of the role and behaviour of the private sector within the health system. Management of the health system as a whole, which is a governmental responsability, therefore requires the integration of planning and regulation in a manner appropriate to each particular context.

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November 23rd , 2007