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

All the Selected for you

BOOK OF THE MONTH

The Economics of Health and Health Care.
L'économie de la santé et des soins médicaux.

Folland S., Goodmann A.C., Stano M.
Boston : Prentice Hall : 2010 : 22 p-601 p.

This clear, step-by-step best-selling introduction to the economics of health and health care thoroughly develops and explains economic ideas and models to reflect the full spectrum of the most current health economics literature. This book uses core economic themes as basic as supply and demand, as venerable as technology or labor issues, and as modern as the economics of information. Chapter topics include health care, health capital, information, health insurance markets, managed care, nonprofit firms, hospitals, physicians and labor, the pharmaceutical industry, government intervention and regulation, and epidemiology and economics. Useful as a reference work for health service researchers, government specialists, and physicians and others in the health care field.

SITES OF THE MONTH

Eurothine

survey.erasmusmc.nl/eurothine

Portail européen des inégalités de santé

www.healthinequalities.org

Projet Ecuity

www2.eur.nl/ecuity

WORKING PAPERS

Health care

Increasing access to health workers in remote and rural areas through improved retention. Global Policy Recommendations.
Renforcer l'accès aux professionnels de santé dans des régions rurales ou isolées grâce à l'amélioration de la fidélisation . Recommandations de politique globale.

World Health Organization. (WHO). Genève. INT, Organisation Mondiale de la Santé. (OMS). Genève.
Genève : OMS : 2010 : 72 p.

La prestation de services de santé efficaces et l'amélioration des résultats sanitaires supposent la présence de personnels de santé qualifiés et motivés en nombre suffisant, au bon endroit et en temps opportun. Une pénurie de personnels de santé qualifiés dans les zones rurales ou reculées prive une part importante de la population de l'accès à des services de soins de santé, ralentit les progrès sur la voie de la réalisation des objectifs du Millénaire pour le développement et contrarie les aspirations liées au but de la santé pour tous. Les recommandations, qui s'appuient sur des données factuelles, ont trait aux mouvements des personnels de santé à l'intérieur des frontières d'un pays et concernent uniquement les stratégies destinées à accroître la disponibilité des personnels de santé dans les zones rurales ou reculées en améliorant l'attraction, le recrutement et la fidélisation.

Hospital

Does Hospital Competition Improve Efficiency? An Analysis of the Recent Market-Based Reforms to the English NHS.
La concurrence hospitalière améliore-t'elle l'efficience. Une analyse des réformes récentes basées sur le marché du NHS anglais.

Cooper Z., Gibbons S., Jones S., McGuire A.
Londres : Centre for Economic Performance : 2010 : 31 p.

This paper uses a difference-in-difference estimator to test whether the introduction of patient choice and hospital competition in the English NHS in January 2006 has prompted hospitals to become more efficient. Efficiency was measured using hospitals' average length of stay (LOS) for patients undergoing elective hip replacement. LOS was broken down into its twokey components: the time from a patient's admission until their surgery and the time from their surgery until their discharge. Our results illustrate that hospitals exposed to competition after a wave of market-based reforms took steps to shorten the time patients were in the hospital prior to their surgery, which resulted in a decrease in overall LOS. We find that hospitals shortened patients' LOS without compromising patient outcomes or by operating on healthier, wealthier or younger patients. Our results suggest that hospital competition within markets with fixed prices can increase hospital efficiency.

Comparing Price Levels of Hospital Services Across Countries: Results of a Pilot Study.
Comparer les niveaux de prix des services hospitaliers dans plusieurs pays : résultat d'une étude pilote.

Koechlin F., Lorenzoni L., Schreyer P.
Paris : OCDE : 2010/07 : 57 p.

Les services de santé représentent une part importante et croissante de la production et des dépenses dans les pays de l'OCDE mais avec des différences notables entre pays dans les dépenses par habitant. Savoir si de telles différences sont dues aux quantités de services consommés dans tel ou tel pays ou reflètent des différences dans les prix des services est une question fondamentale pour mener une politique pertinente. Jusqu'à présent, les comparaisons entre pays du prix des services de santé sont rares et rendues difficiles par les problèmes de mesure. Cet article présente un ensemble de prix comparatifs pour les services hospitaliers dans une sélection de pays de l'OCDE. Ces données sont inédites car elles reflètent « les quasi-prix » (prix négociés ou réglementés ou tarifs) de la production de services hospitaliers. Traditionnellement, les prix de ces produits étaient comparés en utilisant les prix des « input » (approche par les coûts) tels que les taux de salaire du personnel médical. La nouvelle méthodologie s'écarte de cette approche pour tendre vers une approche « output ». Cela devrait permettre de saisir les différences de productivité entre les pays et d'ouvrir la voie à des comparaisons plus significatives du volume des services de santé fournis aux consommateurs dans les différents pays. Un des résultats clés de cette étude pilote est que le niveau de prix des services hospitaliers aux États -Unis est de plus de 60% supérieur au niveau de prix moyen des 12 pays inclus dans l'étude. En revanche, les niveaux de prix sont significativement plus bas en Corée, en Israël et en Slovénie.

The Effect of Waiting Time and Distance on Hospital Choice for English Cataract Patients.
L'effet du temps d'attente et de la distance d'accès sur le choix de l'hôpital par les patients anglais opérés de la cataracte.

Sivey P.
Melbourne : Melbourne Institute of Applied economics and social research : 2010/06 : 29 p.

To date, there has been little data or empirical research on the determinants of doctors' earnings despite earnings having an important role in influencing the cost of health care, decisions on workforce participation and labour supply. This paper examines the determinants of annual earnings of general practitioners and specialists using the first wave of the Medicine in Australia: Balancing Employment and Life (MABEL), a new longitudinal survey of doctors in Australia. For both GPs and specialists, earnings are higher for men, for those who are self-employed, who do after hours or on-call work, and who work in areas with a high cost of living. GPs have higher earnings if they work in larger practices, in outer regional or rural areas, and in areas with lower GP density, whilst specialists earn more if they are a fellow of their college, have more working experience, spend more time in clinical work, have less complex pat ients, or work in inner regional areas. Overall, GPs earn about 32% less than specialists. The returns from on-call work, experience, and self-employment are higher for specialists compared to GPs.

Health inequalities

The story of Determine. Mobilising action for health equity in the EU. Final report of Determine Consortium.
L'histoire de DETERMINE. Se mobiliser pour l'équité en matière de santé au sein de l'Union européenne. Rapport final du Consortium Determine.

Eurohealthnet. Bruxelles. BEL, Determine - EU Consortium for Action on the Socioeconomic Determinants of Health (SDH).
Cologne : Federal Centre for Health Education : 2010 : 35 p.

The main aims of the DETERMINE Consortium were to advance action on health equity in the European Union, to show what can be done and to contribute to global learning. The DETERMINE Consortium highlights the following key messages on what is needed to advance work on addressing the social determinants of health and reducing health inequities: Health systems in EU Member States should ensure that reducing health inequities by addressing their underlying determinants is at the forefront of the policy agenda; Health inequities are a population-based issue. Social position is directly correlated with health, resulting in a ‘health gradient' that affects all groups of society. This needs to be widely understood by policy makers and practitioners within and beyond health systems across the EU. The EU and its Member States should focus on gathering data on health inequities that is understandable, comparable and actionable; Health systems within EU Member States should give greater priority to improving engagement with other policy sectors, promoting ‘health equity in all policies' approaches. This involves developing legislation, reorienting and developing the health workforce and increasing the resource base for health promotion ; the EU and its Member States should invest in and coordinate efforts to develop better regulatory practices to ensure the most efficient and effective use of public resources to improve health equity. This requires more systematic application of and involvement in impact assessments procedures and economic analysis, and investing more in policy research and evaluation; The EU and its Member States have a role to enhance the ability of local level actors to address health inequities by raising awareness about the health gradient and to provide them with tools and mechanisms to work with other sectors and disadvantaged populations on a regular basis ; The EU and its Member States should continue to invest in promoting, exchanging, and building on knowledge in this field, thereby actively supporting efforts to build a stronger basis for crosssectoral work, such as initiated by the DETERMINE partnership and others. This involves exchanging information, building capacities, and greater engagement of the media and the public.

New prospects in the analysis of inequalities in health: a measurement of health encompassing several dimensions of health.
Nouvelles perspectives à l'étude des inégalités de santé : une mesure de la santé prenant en compte les nombreuses dimensions de la santé.

Tubeuf S., Perronnin M.
York : University of York : 2008 : 47 p.

This paper develops an innovative method of constructing a concrete measure of health by taking into account individual health information. Using individual survey data from the 2002 IRDES Health and Health Insurance Survey, we propose a measurement of health based on the number of diseases and their respective severity level. The construction relies on a latent variable regression model explaining self-assessed health and controlling various social and health individual characteristics. We compare this construction to other methods proposed in literature for the measurement of health. Moreover, we show how the health index allows to compare distributions of health among different populations and to evaluate inequalities in health in France by using stochastic dominance at first-order.

Concepts of social justice in the welfare state Great Britain and Germany since 1945.
Les concepts de justice sociale dans les Etats providence que sont la Grande-Bretagne et l'Allemagne depuis 1945.

Torp C.
San Domenico di Fiesole : European University Institute. : 2010 : 17 p.

Concepts of social justice are at the very heart of the welfare state. From the perspective of the history of institutions, the article reconstructs the principles of justice which underlie the architecture of the social security systems in Great Britain and Germany and analyses how they have changed since 1945. It turns out that in general both welfare states are based on mixtures of different concepts of justice. Parallels can be found above all in the health care systems, which in both countries are based on a combination of two principles – equality of access on the one side and treatment according to one's needs on the other side. There are more significant differences, in contrast, in regard to insuring against unemployment and to pension systems, whereby the British welfare state entails a link between the norms of equality and of neediness, whereas in Germany the principle of the equivalence between contributions and benefits is deeply rooted. All path-dependencies notwithstanding, a convergence in the institutional arrangements of both welfare states can be traced over the last decades. In Britain as well as in Germany means-tested benefits and thus the principle of neediness became increasingly important, most notably in the field of unemployment benefits. At the same time, both welfare states experienced the rise of new concepts of justice starting from non-class groups like families, women or generations.

Poverty and social exclusion in the WHO European Region: health systems respond.
La pauvreté et l'exclusion sociale dans la région européenne de l'OMS Europe : les systèmes de santé réagissent.

Koller T.
Copenhague : OMS Bureau regional de l'Europe : 2010 : IV+62 p.

S'inspirant de 22 études de cas réalisées dans la Région européenne de l'OMS, et de 3 documents de référence sur les Roms, les migrants et les enfants, cette publication examine la manière dont les systèmes de santé peuvent répondre aux besoins des populations en proie à la pauvreté et à l'exclusion sociale, et donc plus susceptibles d'être déchues de leur droit à la santé. Ces études révèlent les conditions sociales à l'origine de la forte vulnérabilité des populations, comment des interventions peuvent améliorer l'accessibilité, la disponibilité, l'acceptabilité et la qualité des services de santé, ainsi que la manière dont le système de santé agit sur les inégalités de santé déterminées par les facteurs sociaux en faisant intervenir ses quatre fonctions (stewardship, prestation de services, financement et création de ressources). Les études de cas sont utiles dans la mesure où elles rendent compte de la situation dans les pays. Ainsi ces derniers peuvent-ils tirer des enseignements de l'expérience des autres et, par conséquent, améliorer la santé des populations en proie à la pauvreté et à l'exclusion sociale, tel que demandé dans la résolution EUR/RC52/R7 du Comité régional de l'OMS relative à la pauvreté et à la santé.

Drugs

The Contribution of Pharmaceutical Innovation to Longevity Growth in Germany and France.
La contribution de l'innovation pharmaceutique à l'augmentation de la longévité en Allemagne et en France.

Lichtenberg F.R.
Munich : Center for Economic Studies : 2010/06 : 39 p.

I investigate the contribution of pharmaceutical innovation to recent longevity growth in Germany and France. First, I examine the effect of the vintage of prescription drugs (and other variables) on the life expectancy and age-adjusted mortality rates of residents of Germany, using longitudinal, annual, state-level data during the period 2000-2007. The estimates imply that almost half of the 1.7-year increase in German life expectancy during the period 2000-2007 was due to the replacement of older drugs by newer drugs. Next, I examine the effect of the vintage of chemotherapy treatments on age-adjusted cancer mortality rates of residents of France, using longitudinal, annual, cancer-site-level data during the period 2002- 2006. The estimates imply that chemotherapy innovation accounted for at least one-sixth of the decline in French cancer mortality rates, and may have accounted for as much as half of the decline.

International variation in the usage of medicines. A review of the literature.
Les variations internationale en matière d'utilisation des médicaments. Une revue de la littérature.

Nolte E., Newbould J., Conklin A.
Santa Monica : Rand corporation : 2010 : 43 p.

The report reviews the published and grey literature on international variation in the use of medicines in six areas (osteoporosis, atypical anti-psychotics, dementia, rheumatoid arthritis, cardiovascular disease/lipid-regulating drugs (statins), and hepatitis C). We identify three broad groups of determinants of international variation in medicines use: (1) Macro- or system level factors: Differences in reimbursement policies, and the role of health technology assessment, were highlighted as a likely driving force of international variation in almost all areas of medicines use reviewed. A related aspect is patient co-payment, which is likely to play an important role in the United States in particular. The extent to which cost-sharing policies impact on overall use of medicines in international comparison remains unclear. (2) Service organisation and delivery: Differences in access to specialists are a likely driver of international variation in areas such as atypical anti-psychotics, dementia, and rheumatic arthritis, with for example access to and availability of relevant specialists identified as acting as a crucial bottleneck for accessing treatment for dementia and rheumatoid arthritis. (3) Clinical practice: Studies highlighted the role of variation in the use and ascertainment methods for mental disorders; differences in the use of clinical or practice guidelines; differences in prescribing patterns; and reluctance among clinicians in some countries to take up newer medicines. Each of these factors is likely to play a role in explaining international variation in medicines use, but their relative importance will vary depending on the disease area in question and the system context.

Has the European Union Achieved a Single Pharmaceutical Market?
L'Union européenne est-elle parvenue à réaliser un marché pharmaceutique unique ?

Timur A., Picone G., Desimone J.S.
Cambridge : NBER : 2010/08 : 31 p.

This paper explores price differences in the European Union (EU) pharmaceutical market, the EU's fifth largest industry. With the aim of enhancing quality of life along with industry competitiveness and R&D capability, many EU directives have been adopted to achieve a single EU-wide pharmaceutical market. Using annual 1994–2003 data on prices of molecules that treat cardiovascular disease, we examine whether drug price dispersion has indeed decreased across five EU countries. Hedonic regressions show that over time, cross-country price differences between Germany and three of the four other EU sample countries, France, Italy and Spain, have declined, with relative prices in all three as well as the fourth country, UK, rising during the period. We interpret this as evidence that the EU has come closer to achieving a single pharmaceutical market in response to increasing European Commission coordination efforts.

Long-term care

The long-term care system in Germany.
Le système de soins de longue durée en Allemagne.

Schulz E.
Berlin : DIW : 2010/08 : 47 p.

This document provides an overview of the long-term care system, the number and development of beneficiaries and the long-term care policy in Germany. The report is part of the first stage of the European project ANCIEN (Assessing Needs of Care in European Nations), commissioned by the European Commission under the Seventh Framework Programme (FP7). The first part of the project aims to facilitate structured comparison of the long-term care systems and policies in European Nations. Thus, this report is one of comparable reports provided for most European countries.

The long-term care system in Denmark.
Le système de soins de longue durée au Danemark.

Schulz E.
Berlin : DIW : 2010/08 : 24 p

This document provides an overview of the long-term care system, the number and develop-ment of beneficiaries and the long-term care policy in Denmark. The report is part of the first stage of the European project ANCIEN (Assessing Needs of Care in European Nations), commissioned by the European Commission under the Seventh Framework Programme (FP7). The first part of the project aims to facilitate structured comparison of the long-term care systems and policies in European Nations. Thus, this report is one of comparable reports provided for most European countries.

Primary health care

What Factors Influence the Earnings of GPs and Medical Specialists in Australia? Evidence from the MABEL Survey.
Quels sont les facteurs qui agissent sur les revenus des médecins généralistes et les médecins spécialistes en Australie ? Evidences issues de l'enquête MABEL.

Chai Cheng T., Scott A., Jeong S.H., Kalb G., Humphreys J., Joyce C.M.
Melbourne : Melbourne Institute of Applied economics and social research : 2010/07 : 29 p.

Health care system

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.

Health-Care Reform in Korea.
La réforme des soins de santé en Corée.

Jones R.S.
Paris : OCDE : 2010/07 : 32 p.

Le système de santé coréen a contribué à la nette amélioration de l'état de santé de la population, tout en limitant les dépenses à un niveau qui compte parmi les plus faibles de la zone de l'OCDE, les deux facteurs qui ont joué à cet égard étant la forte participation financière du patient et la couverture limitée de l'assurance-maladie publique. Néanmoins, les dépenses augmentent actuellement au rythme le plus rapide de la zone de l'OCDE. La tendance à la hausse étant appelée à se poursuivre, en particulier à cause du vieillissement rapide de la population, il est indispensable d'accroître l'efficience en réformant le système de paiement, en réduisant les dépenses pharmaceutiques, en ne confiant plus aux hôpitaux les soins de longue durée, en favorisant le vieillissement en bonne santé et en mettant en place un filtrage pour l'accès aux soins. Puisque, du fait du vieillissement de la population, le poids accordé aux paiements d'assurances sociales pour le financement du système de santé constituera de plus en plus un frein pour l'emploi, il est important d'accroître la part du financement de source fiscale. Il faut prioritairement assurer un accès correct des ménages à bas revenu, étant donné le niveau élevé des versements directs. Il faudrait améliorer la qualité des soins en instaurant plus de transparence, en favorisant la restructuration du secteur hospitalier et en augmentant les effectifs de médecins.

Work and Health

Differences in sick leave between employed and unemployed workers: What do they tell us about the health dimension of unemployment?
Les différences en matière d'arrêt maladie entre les travailleurs en activité et les chômeurs : ce qu'elles nous disent à propos de la dimension santé dans le chômage.

Leoni T.
Vienne : Austrian Institute of Economic Research : 2010/06 : 47 p.

Unemployed workers suffer from poor health conditions, a fact which is documented by a large number of studies covering objective health measures, satisfaction with health status and mortality. This paper contributes to the literature with an empirical analysis of sick leave micro-data from Austrian social insurance agencies. The data represent an interesting source of information because in Austria both employed and unemployed workers are entitled to sickness benefits and both groups are subject to almost identical sick pay regulations. Aggregate statistics show that the unemployed spend close to 9 percent of their time on sick leave, against an average of 3.4 percent for the employed. Further evidence indicates that they report much longer illness spells and a higher number of hospitalisations. Both selection and causation effects can help to understand this large gap in health outcomes. Workers who become unemployed had markedly higher absence rates in employment than fellow workers who stay in employment. This difference, which can be interpreted as an approximation for the selection effect, accounts for roughly half of the observed gap in sick leave rates between the employed and the unemployed. On the other hand there exists a positive albeit non-linear relationship between sick leave and unemployment duration, corroborating the view that unemployment impacts health negatively. In accordance with previous studies I find that the unemployed suffer very often from mental disorders. Although women have a higher incidence of mental disorders than men in both employment and unemployment, it is unemployed men who experience the sharpest increase in mental problems in the wake of unemployment.