1,721,026 research outputs found
Sistemi di remunerazione per l'assistenza primaria in un contesto di asimmetria informative
No full textTraditional health economics assumes that the patient should always consult a primary cone pshysician to get information on his condition and on the type of care suitable for him. This framework is no longer able to capture the actual world because GP's play a marginal role as therapist, their role evolving into gatekeepers and /or an information channel, and patients are (or they think they are) better informed than in the past. Asymmetry of information, incentives and patients' choices should be taken into account when the payment scheme is put in force for physicians. In the literature a long debate has developed about the best method of payment to be used and the most recent contributions seems to be oriented towards a mixed payment scheme as the one proposed by Levaggi and Rochaix (2003). The validity of these theoretical contributions is not in discussion, but most of this literature has not taken into account the role of the patient and his choice. If, as the recent literature suggests, the patient has information on his condition, forms of horizontal competition between GP's and specialists can be developed to reduce the cost of asymmetry of information. The aim of the paper is to show how forms of payment and the organisation of the service interact when the patient can make choices between GP's and specialists. The interesting result of our analysis is that systems of organisation and payment allowing the patient to choose, even if he has not got any prior on his disease, reduces the monopoly power of the GP hence the cost of treatment for society
Investment in Hospital Care Technology under Different Purchasing Rules: A Real Option Approach
No full textQuality of health care is the product of several factors as the literature has long recognized. In this paper we focus on the relationship between quality and investment in health technology by analysing the optimal investment decision in a new health care technology of a representative hospital that maximizes its surplus in an uncertain environment. The new technology allows the hospital to increase the quality level of the care provided, but the investment is irreversible. The paper uses the framework of the real option literature to show how the purchaser might influence the quality level by setting a quality-contingent long-term contract with the hospital. The investment in new technology is in fact best incentivated within a long-term contract where the number of treatments reimbursed depends on the level of investment made when the technology is new. In this way, asymmetry of information does not affect the outcome of the contract. In our model in fact the purchaser can verify the level of the investment only at the end of each period but the purchasing rule has an anticipating effect on the decision to invest
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
Investment in Quality of Health Care
No full textWorking Paper Dipartimento di Scienze Economiche-Università di Bresci
Pricing policies in the pharmaceutical sector
No full textIn this article we analyze the problem of determining the price for new drugs in a market where stringent budget constraints on public expenditure exists and we suggest an innovative methodology to set drug prices. The market is characterized by asymmetry of information and a high proportion of investment in research and development, an element that must be taken into account because it is only through research that it is possible to obtain better drugs. Our proposed method allows one to set the price of new drugs in different market contexts, that is, where less effective alternatives are already sold or in new markets. We also propose a unified methodology to evaluate the social value of drugs in different markets through the definition of a function of the cost per quality adjusted life year that society is willing to pay
Flypaper Effect and the Sluggishness: Evidence from Regional Health Expenditure in Italy
No full textWith a little help from my (neighbouring) friends. ‘Border region patient mobility’ in the European Union: A policy analysis
No full textIncreased disparities in income and health care expenditure across EU countries may lead to an increase in patient mobility, which may, in turn, call for more action by the EU and its Member States. At present, patient mobility (or cross-border healthcare) is still a marginal phenomenon but is deemed to increase in the future. In this paper we examine border region patient mobility, defined as patients receiving care in a neighbouring country within a certain proximity. We examine, with the use of a spatial competition model, the options used to regulate such a patient flow and their welfare implications, both for patients and Governments. We show that marginal price costing would lead to an increase in patient welfare, whilst reducing the risk of increasing cost for the exporting country. At present there seems to be an East/West difference in the way these flows are regulated. In order to increase equity, we suggest that a ‘joint implementation’ of EU Directives by neighbouring Member States, especially in the field of cross-border healthcare, would allow Member States to define target populations (in terms of type of care and distance travelled) that could allow more freedom in terms of border care, without increasing health care expenditure. A future combination of the two existing legal frameworks in this field would also be more user- or patient-friendly
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