264 research outputs found
Pricing Personalised Drugs: Comparing Indication Value Based Prices with Performance Based Schemes
No full textPrice strategies are essential to balance timely access to drugs with expenditure containment. This is especially true for personalised drugs, whose effectiveness is heterogeneous across patients. For these drugs, some authors suggest to use Indication Based Price schemes (IBPs), while others argue that Performance-Based managed entry Agreements (PBAs) are more appropriate. We develop a theoretical model to compare the welfare properties of IBPs and PBAs in an environment where effectiveness is uncertain. The manufacturer observes heterogeneity in patients responses, but this information may be non verifiable. By contrast, the regulator can only observe data presented for listing purposes. We show that IBPs may allow to treat the efficient number of patients only if the social value of the drug is entirely appropriated by the manufacturer. PBAs may allow a fairer distribution of the social value, but their success depends on the contract rules and on the degree of uncertainty
Strategic costs and preferences revelation in the allocation of resources for health care
No full textInternal market, Asymmetry of information, Intrinsic motivation, I11, I18,
Welfare properties of restrictions to health care based on cost effectiveness
No full textIn this note we explore the welfare properties of access restrictions to health care based on cost effectiveness. We show that such instrument can improve the average effectiveness of health care, but it is optimal only under specific assumptions relating to the shape of the welfare function and the utility of health care. Copyright (C) 2009 John Wiley & Sons, Ltd.cost effectiveness , welfare analysis ,
Patients Mobility Across Borders: A Welfare Analysis
No full textWelfare systems are designed on geographical and membership boundaries. In terms of access to health care this implies that, as a general rule, only individuals residing in their national territory can obtain health care from providers located there. However, in the past few years medical tourism has grown at an explosive pace throughout the world and in Europe. Each year in fact a small, but significant number of European citizens seek medical treatment that is financed by their public insurer in another EU country. From an economic point of view, it is important to distinguish between the two following sources of patients’ mobility: a regulated mobility, where the third payer decides to send patients abroad and patients’ choice, where the patient himself decides to seek care abroad. In this article we show how the combined effect of restrictions to the use of health care, transfer prices, and mobility rules determine social welfare and its allocation between Regions. The results are quite interesting: if the price set for these patients is equal to the marginal cost of the more efficient Region, patients’ mobility should be preferred to patients’ choice. On the other hand, if the price is equal to the marginal cost of the less efficient Region, patient choice should be preferred. The other interesting result is a possible trade off between a static model where each Region chooses its level of cost/effectiveness and a more long term situation, where patient mobility determines a common level for this parameter
Exit, Choice or Loyalty: Patient Driven Competition in Primary Care
No full textforthcoming in decembe
Waste-to-energy in the EU: The effects of plant ownership, waste mobility, and decentralization on environmental outcomes and welfare
No full textWaste-to-energy (WtE) could prevent the production of up to 50 million tons of CO2 emissions that would otherwise be generated by burning fossil fuels. Yet, support for a large deployment of WtE plants is not universal because there is a widespread concern that energy from waste discourages recycling practices. Moreover, incineration plants generate air pollution and chemical waste residuals and are expensive to build compared to modern landfills that have appropriate procedures for the prevention of leakage of harmful gasses. In the context of the EU, this paper aims to provide a picture of the actual role of WtE as a disposal option for municipal solid waste (MSW), enabling it to be utilized as a source of clean energy, and to address two important aspects of the debate surrounding the use of WtE; namely, (i) the relationship between WtE and recycling, and (ii) the effects of decentralization, waste mobility, and plant ownership. Finally, it reviews the role of the EU as a supranational regulator, which may allow the lower government levels (where consumer preferences are better represented) to take decisions, while taking spillovers into account
Optimal incentive schemes for physicians
No full textIncreasingly, physicians’ payment schemes are being reformed to en- hance performance and to ensure an optimal allocation of scarce medical resources. The empirical evidence points towards the use of mixed payment schemes that appear better at achieving efficiency than either lump sum payments (such as cap- itation) or piece rates (fee for service). Yet, this alleged superiority remains to be established from a theoretical standpoint. The Principal-Agent model developed in this paper offers a contribution in this line, with a primary care physician as agent and a public regulator as principal. Alternative specifications of the princi- pal’s objective function are considered in the model (efficiency versus fairness). Uncertainty is introduced by two random variables that represent the probability for an individual of being ill and his productivity parameter which determines the amount of resources (the physician’s effort in particular) necessary to restore health. The relationship is characterised by information asymmetry since the physician is assumed to observe both variables after the contract has been signed, but before choosing his effort level. Both selection and moral hazard issues are addressed in the model and the results show that, under GP risk neutrality, mixed payment schemes fully correct for both types of information asymmetry.info:eu-repo/semantics/publishedVersio
Beyond price: the effects of non-financial barriers on access to drugs and health outcomes
No full textObjectives: We study the impact of the pharmacy dispensing channel (as a proxy for access to drugs) on the drug purchases, health outcomes, and health care utilization (emergency room visits or hospitalizations) of chronically ill patients in Liguria, Italy, in 2017. Methods: We use the coarsened exact matching algorithm to compare the health outcomes for a treated group of patients living in a local health authority (LHA) where drug distribution through community pharmacies was restricted. These patients were matched to a control group of patients living in other LHAs, where drugs were also dispensed through a broad network of community pharmacies. We exploit a unique administrative dataset with information on the socio-demographic characteristics and health care services utilization of Ligurian patients with chronic cardiovascular and respiratory ailments. We restrict our analysis to patients 65 years of age or older who were admitted to hospitals from 2013 to 2016 with either a principal or secondary diagnosis connected to chronic cardiovascular and respiratory diseases. Results: Reduced access to drugs leads to lowered drug consumption, a higher probability of adverse health outcomes including mortality, and a higher consumption of medical services in terms of hospitalizations and emergency room visits. These effects increase with patients' age. Conclusion: The pharmacy dispensing channel significantly affects drug consumption and acts as a proxy for adherence among chronically ill patients. Thus, health outcomes and health care utilization should be carefully evaluated when comparing the costs of alternative dispensing channels
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