1,720,994 research outputs found
Delegating home care for the elderly to external caregivers? An empirical study on Italian data
No full textWe study care arrangement decisions in Italy, where families are increasingly delegating the role of primary
caregiver to external (paid) people also for the provision of home care. We consider a sample of households
with a dependent elderly person cared for either at home or in a residential home, extracted from a survey
representative of the population of Italy’s Emilia-Romagna region. We investigate the determinants of a
household’s decision to opt for one of the following three alternatives: the institutionalisation of elderly family
members, informal home care, or paid home care. We estimate two model specifications, based on a
simultaneous and a sequential decision process respectively, the results of which are fairly consistent.
Disability related variables, rather than family characteristics, emerge as the main determinants of
institutionalisation. On the other hand, household characteristics and socio-economic variables are more
influential when it comes to choosing between informal and formal home care provisions
Mutue Sanitarie e Meccanismi Assicurativi
No full textL'articolo analizza il ruolo delle mutue sanitarie quale strumento di potenziale attenuazione dei fallimenti del mercato assicurativo prendendo in esame gli aspetti di efficienza, equità e solidarietà che caratterizzano i processi di socializzazione dei rischi
Does the extension of primary care practice opening hours reduce the use of emergency services?
Full text linkOvercrowding in emergency departments generates potential inefficiencies. Using regional administrative data, we investigate the impact that an increase in the accessibility of primary care has on emergency visits in Italy. We consider two measures of avoidable emergency visits recorded at list level for each General Practitioner. We test whether extending practices' opening hours to up to 12 hours/day reduces the inappropriate utilization of emergency services. Since subscribing to the extension program is voluntary, we account for the potential endogeneity of participation in a count model for emergency admissions in two ways: first, we use a two-stage residual inclusion approach. Then we exploit panel methods on data covering a three-year period, thus accounting directly for individual heterogeneity. Our results show that increasing primary care accessibility acts as a restraint on the inappropriate use of emergency departments. The estimated effect is in the range of a 10-15% reduction in inappropriate admissions
Spatial effects in hospital expenditures: A district level analysis
Full text linkWe use spatial econometric methods to analyse spillovers in hospital expenditures across Health Districts of the Emilia-Romagna Region (Italy). We estimate spatial models that allow for global spillovers and distinguish between the expenditures associated with potentially inappropriate hospitalizations and those associated with complex medical procedures. We also investigate the relative contribution of geographical and institutional proximity in explaining spatial dependence, by explicitly modelling different connectivity structures and exploiting them to build alternative spatial weight matrices. We find that interactions largely differ between types of expenditures, with positive spatial effects for potentially inappropriate admissions, the effect being generally not significant for high-complexity expenditure. Relying on the estimated direct and indirect effects, we also test for the presence of spatial spillovers across districts. Finally, the paper draws policy implications for the public health planner
Price Changes in Regulated Healthcare Markets: Do Public Hospitals Respond and How?
Full text linkThis paper examines the behaviour of public hospitals in response to the average payment
incentives created by price changes for patients classified in different Diagnosis Related
Groups (DRGs). Using panel data on public hospitals located within the Italian region of
Emilia-Romagna, we test whether a one-year increase in DRG prices induced public
hospitals to increase their volume of activity, and whether a potential response is associated
with changes in waiting times and/or length of stay. We find that public hospitals reacted to
the policy change by increasing the number of patients with surgical treatments. This effect
was smaller in the two years after the policy change than in later years, and for providers
with a lower excess capacity in the pre-policy period, whereas it did not vary significantly
across hospitals according to their degree of financial and administrative autonomy. For
patients with medical DRGs, instead, there appeared to be no effect on inpatient volumes.
Our estimates also suggest that an increase in DRG prices either decreased or had no impact
on the proportion of patients waiting more than six months. Finally, we find no evidence of
a significant effect on patients’ average length of stay
Quality in Nursing Homes
No full textIn developed countries, the role of public authorities as financing bodies and regulators of the long-term care sector is pervasive and calls for well-planned and informed policy actions. Poor quality in nursing homes has been a recurrent concern at least since the eighties and has triggered a heated policy and scholarly debate. The economic literature on nursing home quality has thoroughly investigated the impact of regulatory interventions and of market characteristics on an array of input-, process- and outcome-based quality measures. Most existing studies refer to the US context, even though important insights can be drawn also from the smaller set of works that covers European countries.
The major contribution to the empirical analysis of the nursing home industry is represented by the introduction of important methodological advances applying rigorous policy evaluation techniques with the purpose of properly identifying the causal effects of interest.
The use of up-to-date econometric methods that, in most cases, exploit policy shocks and longitudinal data has given researchers the possibility to achieve a causal identification of the impact of a wide range of policy initiatives, including the introduction of nurse staffing thresholds, price regulation, and public reporting of quality indicators. This has permitted to overcome part of the contradictory evidence highlighted by the strand of works based on more descriptive evidence. Possible lines for future research can be identified in further exploration of the consequences of policy interventions in terms of equity and accessibility to nursing home care
Dealing with minor illnesses: The link between primary care characteristics and Walk-in Centres' attendances
Full text linkThe reformulation of existing boundaries between primary and secondary care, in order to shift selected services traditionally provided by Emergency Departments (EDs) to community-based alternatives, has determined a variety of organisational solutions. One innovative change has been the introduction of fast-track systems for minor injuries or illnesses, whereby community care providers are involved in order to divert patients away from EDs. These facilities offer an open-access service for patients not requiring hospital treatments, and may be staffed by nurses and/or primary care general practitioners operating within, or alongside, the ED. To date little research has been undertaken on such experiences. To fill this gap, we analyse a Walk-in Centre (WiC) in the Italian city of Parma, consisting of a minor injury unit located alongside the teaching hospital's ED. We examine the link between the utilisation rates of the WiC and primary care characteristics, focusing on the main organisational features of the practices and estimating panel count data models for 2007-2010. Our main findings indicate that the extension of practice opening hours significantly lowers the number of attendances, after controlling for General Practitioner's and practice's characteristics
Patient preferences and cost-benefit of hypertension and hyperlipidemia collaborative management model between pharmacies and primary care in Portugal: A discrete choice experiment alongside a trial (USFarmácia®)
No full textBackground: Little is known about patient preferences and the value of pharmacy-collaborative disease management with primary care using technology-driven interprofessional communication under real-world conditions. Discrete Choice Experiments (DCEs) are useful for quantifying preferences for non-market services. Objectives: 1) To explore variation in patient preferences and estimate willingness-to-accept annual cost to the National Health Service (NHS) for attributes of a collaborative intervention trial between pharmacies and primary care using a trial exit DCE interview; 2) to incorporate a DCE into an economic evaluation using cost-benefit analysis (CBA). Methods: We performed a DCE telephone interview with a sample of hypertension and hyperlipidemia trial patients 12 months after trial onset. We used five attributes (levels): waiting time to get urgent/not urgent medical appointment (7 days/45 days; 48 hrs./30 days; same day/15 days), model of pharmacy intervention (5-min. counter basic check; 15-min. office every 3 months for BP and medication review of selected medicines; 30-min. office every 6 months for comprehensive measurements and medication review of all medicines), integration with primary care (weak; partial; full), chance of having a stroke in 5 years (same; slightly lower; much lower), and annual cost to the NHS (0€; 30€; 51€; 76€). We used an experimental orthogonal fractional factorial design. Data were analyzed using conditional logit. We subtracted the estimated annual incremental trial costs from the mean WTA (Net Benefit) for CBA. Results: A total of 122 patients completed the survey. Waiting time to get medical appointment—on the same day (urgent) and within 15 days (non-urgent)—was the most important attribute, followed by 30-minute pharmacy intervention in private office every 6 months for point-of-care measurements and medication review of all medicines, and full integration with primary care. The cost attribute was not significant. Intervention patients were willing to accept the NHS annual cost of €877 for their preferred scenario. The annual net benefit per patient is €788.20 and represents the monetary value of patients’ welfare surplus for this model. Conclusions: This study is the first conducted in Portugal alongside a pharmacy collaborative trial, incorporating DCE into CBA. The findings can be used to guide the design of pharmacy collaborative interventions with primary care with the potential for reimbursement for uncontrolled or at-risk chronic disease patients informed by patient preferences. Future DCE studies conducted in community pharmacy may provide additional contributions. Trial registration: Current Controlled Trials (ISRCTN): ISRCTN13410498, retrospectively registered on 12 December 2018
Disability and the achievement of Universal Health Coverage in the Maldives.
Full text linkObjectiveTo assess access to general and disability-related health care among people with disabilities in the Maldives.MethodsThis study uses data from a case-control study (n = 711) nested within a population-based, nationally representative survey to compare health status and access to general healthcare amongst people with and without disabilities. Cases and controls were matched by gender, location and age. Unmet need for disability-related healthcare is also assessed. Multivariate regression was used for comparisons between people with and without disabilities.ResultsPeople with disabilities had poorer levels of health compared to people without disabilities, including poorer self-rated health, increased likelihood of having a chronic condition and of having had a serious health event in the previous 12 months. Although most people with and without disabilities sought care when needed, people with disabilities were much more likely to report difficulties when routinely accessing healthcare services compared to people without disabilities. Additionally, 24% of people with disabilities reported an unmet need for disability-related healthcare, which was highest amongst people with hearing, communication and cognitive difficulties, as well as amongst older adults and people living in the lowest income per capita quartile. Median healthcare spending in the past month was modest for people with and without disabilities. However, people with disabilities appear to have high episodic healthcare costs, such as for disability-related healthcare and when experiencing a serious health event.ConclusionsThis study found evidence that people with disabilities experience unmet needs for both disability-related and general healthcare. There is therefore evidence that people with disabilities in the Maldives are falling behind in core components relevant to UHC: availability of all services needed, and quality and affordability of healthcare
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